Provider Demographics
NPI:1285747493
Name:CRAIG, KAREN JENELL (CFNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JENELL
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JENELL
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 E 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3209
Mailing Address - Country:US
Mailing Address - Phone:706-509-3278
Mailing Address - Fax:706-509-4600
Practice Address - Street 1:304 TURNER MCCALL BLVD
Practice Address - Street 2:THE BREAST CENTER
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-0233
Practice Address - Country:US
Practice Address - Phone:706-509-6852
Practice Address - Fax:706-509-6858
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA161722931AMedicaid
50BBHPHMedicare ID - Type Unspecified
Q18972Medicare UPIN