Provider Demographics
NPI:1194943712
Name:PAYSON, KAREN L (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:PAYSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:PAYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:645 SW COLONY RD
Mailing Address - City:CRARYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12521-0262
Mailing Address - Country:US
Mailing Address - Phone:518-325-7280
Mailing Address - Fax:
Practice Address - Street 1:645 SW COLONY RD
Practice Address - Street 2:PO 262
Practice Address - City:CRARYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12521
Practice Address - Country:US
Practice Address - Phone:518-325-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-330336-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily