Provider Demographics
NPI:1427167113
Name:IMPSON, KAREN DYAN (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DYAN
Last Name:IMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 E MERIDIAN LOOP
Mailing Address - Street 2:SUITE D
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7270
Mailing Address - Country:US
Mailing Address - Phone:907-373-7337
Mailing Address - Fax:907-357-9029
Practice Address - Street 1:3719 E MERIDIAN LOOP
Practice Address - Street 2:SUITE D
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7270
Practice Address - Country:US
Practice Address - Phone:907-373-7337
Practice Address - Fax:907-357-9029
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD10661Medicaid