Healthcare Provider Details

I. General information

NPI: 1649624404
Provider Name (Legal Business Name): KARRIE MARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 UPLAND ST
KENAI AK
99611-8026
US

IV. Provider business mailing address

213 CLEARVIEW DRIVE EXT
GREER SC
29651-1107
US

V. Phone/Fax

Practice location:
  • Phone: 907-335-7500
  • Fax:
Mailing address:
  • Phone: 734-431-0778
  • Fax: 864-442-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10016905
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25338
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704303950
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024187032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: