Healthcare Provider Details

I. General information

NPI: 1619900206
Provider Name (Legal Business Name): KAREN JOYCE LESSARIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/16/2023
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 2ND STREET, NW STE. 205
HICKORY NC
28601
US

IV. Provider business mailing address

P.O. BOX 1305
HICKORY NC
28603
US

V. Phone/Fax

Practice location:
  • Phone: 828-345-0877
  • Fax: 828-345-0514
Mailing address:
  • Phone: 828-345-0877
  • Fax: 828-345-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200000516
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number200000516
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier89126HN
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
IdentifierN0051A
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 3
Identifier1619900206
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 4
Identifier126HN
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNCBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: