Healthcare Provider Details

I. General information

NPI: 1356904502
Provider Name (Legal Business Name): KARA GENO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7129
US

IV. Provider business mailing address

8063 BURGUNDY CIR
CHATTANOOGA TN
37421-1290
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-8989
  • Fax:
Mailing address:
  • Phone: 423-361-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25754
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021288
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83666-092
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: