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NPI Code Detail

MEDICARE: KAREN L GIBBONS-BERRY FNP

MEDICARE: KAREN L GIBBONS-BERRY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner202001584NP-PPOR
2363LF0000XFamily Nurse PractitionerR093348GA

General Provider Information

NPI Number : 1861448227
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN L GIBBONS-BERRY FNP
Provider Business Mailing Address
First Line : 811 13TH ST
Second Line : SUITE 10
City : AUGUSTA
State : GA
Zip : 30901-2700
Country : US
Telephone Number : 706-434-1590
Fax Number : 803-279-6001
Provider Business Practice Location Address
First Line : 811 13TH ST
Second Line : SUITE 10
City : AUGUSTA
State : GA
Zip : 30901-2700
Country : US
Telephone Number : 706-434-1590
Fax Number : 803-279-6001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 02/20/2020

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