Provider Demographics
NPI:1215246590
Name:CARSON, KAREN ALDEN (ANP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ALDEN
Last Name:CARSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DENISE
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 MEDICAL PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8541
Practice Address - Country:US
Practice Address - Phone:980-302-7070
Practice Address - Fax:980-302-7075
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE, GROUP PTAN
NC2595059OtherMEDICARE PTAN, INDIVIDUAL