Provider Demographics
NPI:1962871368
Name:ODONNELL, KAREN (AGNPPC-NP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:AGNPPC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 CANVAS DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6145
Mailing Address - Country:US
Mailing Address - Phone:919-961-0003
Mailing Address - Fax:
Practice Address - Street 1:101 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1935
Practice Address - Country:US
Practice Address - Phone:252-813-9519
Practice Address - Fax:252-824-0389
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008024363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health