Provider Demographics
NPI:1487719597
Name:KARR, MEDEA REVERELLY (NP)
Entity type:Individual
Prefix:
First Name:MEDEA
Middle Name:REVERELLY
Last Name:KARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2740
Mailing Address - Country:US
Mailing Address - Phone:206-734-4981
Mailing Address - Fax:888-734-4981
Practice Address - Street 1:4520 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2740
Practice Address - Country:US
Practice Address - Phone:206-734-4981
Practice Address - Fax:888-734-4981
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8876853OtherPTAN