Provider Demographics
NPI:1952387813
Name:RAFFENSPERGER, KAREN LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:RAFFENSPERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 PRESCOTT LAKES PKWY APT 124
Mailing Address - Street 2:MANSFIELD HILL
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-7827
Mailing Address - Country:US
Mailing Address - Phone:928-443-7382
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL SERVICES OF PRESCOTT
Practice Address - Street 2:1003 WILLOW CREEK ROAD
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-771-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000529Medicaid
WVMM0113299OtherDEA
WVMOPA74711Medicare ID - Type Unspecified
WVS70461Medicare UPIN