Basic Information
| Provider Information | |||||||||
| NPI: | 1417065871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | KAREN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 EAST STATE STREET | ||||||||
| Address2: | PO BOX 1250 | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187754360 | ||||||||
| FaxNumber: | 5187735237 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 EAST STATE STREET | ||||||||
| Address2: | MAB SUITE 101 | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187754360 | ||||||||
| FaxNumber: | 5187735237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 01/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | F420519 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 02329073 | 05 | NY | MEDICAID | 351744 | 01 | NY | MVP HEALTHCARE | OTHER | PRC200221387 | 01 | NY | CDPHP | OTHER |