Provider Demographics
NPI:1104971001
Name:STEVENSON, KAREN DENISE (RN, BSN, MS)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DENISE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN, BSN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0847
Mailing Address - Country:US
Mailing Address - Phone:575-562-4455
Mailing Address - Fax:
Practice Address - Street 1:520 NORTH GRIFFIN STREET
Practice Address - Street 2:
Practice Address - City:TEXICO
Practice Address - State:NM
Practice Address - Zip Code:88135
Practice Address - Country:US
Practice Address - Phone:505-482-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250245163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME7641Medicaid