MEDICARE: KAREN DEAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-026442	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51517350	OTHER	AL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	51044084	OTHER	AL	BCBS
6	51517348	OTHER	AL	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942288220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DEAN CRNP

Provider Business Mailing Address
First Line	:	1000 ADAMS AVE
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-4424
Country	:	US
Telephone Number	:	334-263-2301
Fax Number	:	334-263-0881

Provider Business Practice Location Address
First Line	:	100 E VANDIVER BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1812
Country	:	US
Telephone Number	:	334-832-4338
Fax Number	:	334-832-9971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	04/21/2010

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Directions to “ KAREN DEAN CRNP” Practice Location

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