Healthcare Provider Details

I. General information

NPI: 1194814921
Provider Name (Legal Business Name): KARYN DEAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARYN COHENOUR APN

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S 3RD ST
HAYTI MO
63851-1617
US

IV. Provider business mailing address

420 SEMO DR
NEW MADRID MO
63869-1734
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-9803
  • Fax:
Mailing address:
  • Phone: 573-748-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: