Provider Demographics
NPI:1063553840
Name:LAND, KAREN ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:LAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2401 VILLAGE PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4702
Mailing Address - Country:US
Mailing Address - Phone:334-749-8121
Mailing Address - Fax:334-749-6166
Practice Address - Street 1:2401 VILLAGE PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4702
Practice Address - Country:US
Practice Address - Phone:334-749-8121
Practice Address - Fax:334-749-6166
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037856363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-037856OtherALA BOARD NURSING LICENSE
AL890005170Medicaid