Provider Demographics
NPI:1306870951
Name:HYATT, KAREN G (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:G
Last Name:HYATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:G
Other - Last Name:GLADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4750 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1663
Mailing Address - Country:US
Mailing Address - Phone:636-498-4555
Mailing Address - Fax:
Practice Address - Street 1:300 59TH ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-2261
Practice Address - Country:US
Practice Address - Phone:636-498-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1182372085N0700X
TN571862085N0700X, 2085R0202X
VA01010552882085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102635Medicaid
MO204976005Medicaid
300112438OtherRAILROAD MEDICARE NUMBER