Provider Demographics
NPI:1740162270
Name:VANN, KARLIE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:VANN
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OPAL CT STE 311
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5943
Mailing Address - Country:US
Mailing Address - Phone:240-384-4679
Mailing Address - Fax:
Practice Address - Street 1:1101 OPAL CT STE 311
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5943
Practice Address - Country:US
Practice Address - Phone:240-384-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219778363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health