Provider Demographics
NPI:1366810426
Name:KARNES, VICKI KAREN (RN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:KAREN
Last Name:KARNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BOULEVARD NE
Mailing Address - Street 2:4TH FLOOR - ATTN: PAT JACKSON
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1208
Mailing Address - Country:US
Mailing Address - Phone:404-312-5079
Mailing Address - Fax:404-982-0661
Practice Address - Street 1:265 BOULEVARD NE
Practice Address - Street 2:4TH FLOOR ATTN: PAT JACKSON
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1208
Practice Address - Country:US
Practice Address - Phone:404-312-5079
Practice Address - Fax:404-982-0661
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse