Healthcare Provider Details

I. General information

NPI: 1093168890
Provider Name (Legal Business Name): KAREN DENISE MEDLOCK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WINDWARD PEAK CT
GREER SC
29651-5003
US

IV. Provider business mailing address

120 WINDWARD PEAK CT
GREER SC
29651-5003
US

V. Phone/Fax

Practice location:
  • Phone: 864-275-2251
  • Fax: 864-895-1144
Mailing address:
  • Phone: 864-275-2251
  • Fax: 864-895-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number93969
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: