Healthcare Provider Details

I. General information

NPI: 1093153207
Provider Name (Legal Business Name): KARLEEN CAROL ADAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLEEN CAROL ADAMS SMITH

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 07/21/2022
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 928-263-4722
  • Fax: 928-263-4794
Mailing address:
  • Phone: 928-263-4722
  • Fax: 928-263-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number008829
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberD02063
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: