Provider Demographics
NPI:1962720342
Name:PRESTON, KAREN E (CRNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:PRESTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8566
Mailing Address - Country:US
Mailing Address - Phone:704-696-8220
Mailing Address - Fax:
Practice Address - Street 1:1040 EDGEWATER CORP PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4514
Practice Address - Country:US
Practice Address - Phone:704-541-9117
Practice Address - Fax:704-541-9137
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2025-05-16
Deactivation Date:2025-04-10
Deactivation Code:
Reactivation Date:2025-05-16
Provider Licenses
StateLicense IDTaxonomies
NC5006697363LF0000X
SC19393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC19393OtherSCBON
PASP010827OtherLICENSE
PA185620JZWOtherMEDICARE NUMBER
NC5006697OtherNCBON