Provider Demographics
NPI:1588760904
Name:STAPLES, KAREN L (FNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:STAPLES
Suffix:
Gender:F
Credentials:FNP
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-756-7885
Mailing Address - Fax:843-756-7855
Practice Address - Street 1:3418 CASEY ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2904
Practice Address - Country:US
Practice Address - Phone:843-756-7885
Practice Address - Fax:843-756-7855
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201657363LF0000X
SC1211363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20630OtherNP LICENSE NUMBER
MS0245868OtherDEA NUMBER
P93474Medicare UPIN