Healthcare Provider Details

I. General information

NPI: 1164664348
Provider Name (Legal Business Name): KAREN EDWARDS SEAGO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 DOCTORS DR
PEARL MS
39208-4042
US

IV. Provider business mailing address

2550 FLOWOOD DR SUITE 402
FLOWOOD MS
39232-9303
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-8722
  • Fax: 601-939-2623
Mailing address:
  • Phone: 601-936-3121
  • Fax: 601-936-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR701653
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR701653
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: