Healthcare Provider Details

I. General information

NPI: 1942936687
Provider Name (Legal Business Name): KAREN RENEE CLIFTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6057 TOWNSHIP ROAD 49
GALION OH
44833-9661
US

IV. Provider business mailing address

6057 TOWNSHIP ROAD 49
GALION OH
44833-9661
US

V. Phone/Fax

Practice location:
  • Phone: 419-512-2398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP0033980
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN414771
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: