Provider Demographics
NPI:1699495432
Name:PEMBERTON, KARINA NICOLLE (NP)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:NICOLLE
Last Name:PEMBERTON
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 1:1240 MIDTOWN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-2947
Mailing Address - Country:US
Mailing Address - Phone:607-768-1214
Mailing Address - Fax:
Practice Address - Street 1:4520 BROAD ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2422
Practice Address - Country:US
Practice Address - Phone:843-756-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily