Basic Information
Provider Information
NPI: 1467701797
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARMON
FirstName: KAREN
MiddleName: DEANNA
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 611 MOCKSVILLE AVE
Address2:  
City: SALISBURY
State: NC
PostalCode: 281442705
CountryCode: US
TelephoneNumber: 7046337220
FaxNumber: 7046470515
Practice Location
Address1: 611 MOCKSVILLE AVE
Address2:  
City: SALISBURY
State: NC
PostalCode: 281442705
CountryCode: US
TelephoneNumber: 7046337220
FaxNumber: 7046470515
Other Information
ProviderEnumerationDate: 08/31/2012
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X5005773NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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