1649593112 NPI number — MS. KAREN LYNN FREDERICK M.S.N., F.N.P.-B.C.

Table of content: MS. KAREN LYNN FREDERICK M.S.N., F.N.P.-B.C. (NPI 1649593112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649593112 NPI number — MS. KAREN LYNN FREDERICK M.S.N., F.N.P.-B.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREDERICK
Provider First Name:
KAREN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.N., F.N.P.-B.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649593112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38344-0525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-986-2213
Provider Business Mailing Address Fax Number:
731-986-0011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 HIGHWAY 641 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38320-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-584-1523
Provider Business Practice Location Address Fax Number:
731-584-1543
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  14836 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com