Provider Demographics
NPI:1487701728
Name:KARL, JOHN J (FNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KARL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-0800
Mailing Address - Country:US
Mailing Address - Phone:219-864-2107
Mailing Address - Fax:
Practice Address - Street 1:3700 W 203RD ST STE 302
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1182
Practice Address - Country:US
Practice Address - Phone:708-679-2518
Practice Address - Fax:708-679-2519
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-258664163WR0006X
IN71009040A163WR0006X, 363L00000X
IN28163347A363L00000X
IL041258664363L00000X
IL209.019289363LF0000X
IL209019289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.019289OtherADVANCE PRACTICE REGISTERED NURSE FNP-C