Provider Demographics
NPI:1063123198
Name:SEABOLT, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SEABOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 ELY FRK
Mailing Address - Street 2:
Mailing Address - City:SUMERCO
Mailing Address - State:WV
Mailing Address - Zip Code:25567-9710
Mailing Address - Country:US
Mailing Address - Phone:304-553-6390
Mailing Address - Fax:
Practice Address - Street 1:558 ELY FRK
Practice Address - Street 2:
Practice Address - City:SUMERCO
Practice Address - State:WV
Practice Address - Zip Code:25567-9710
Practice Address - Country:US
Practice Address - Phone:304-553-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant