Provider Demographics
NPI:1487996617
Name:KOENIG, KAREN A (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:KOENIG
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 1:2603 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-3807
Mailing Address - Country:US
Mailing Address - Phone:217-528-0307
Mailing Address - Fax:217-528-0034
Practice Address - Street 1:1304 BURNETT DR
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-9519
Practice Address - Country:US
Practice Address - Phone:217-321-9310
Practice Address - Fax:217-321-9307
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010343363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA0213081OtherAANP CERTIFICATION