Provider Demographics
NPI:1215904230
Name:VALK, KAREN BRYANT (FNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:BRYANT
Last Name:VALK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 OTARI DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5200
Mailing Address - Country:US
Mailing Address - Phone:423-246-4445
Mailing Address - Fax:
Practice Address - Street 1:112 BEECH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3638
Practice Address - Country:US
Practice Address - Phone:276-386-1312
Practice Address - Fax:276-386-2116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ16147Medicare UPIN