Basic Information
| Provider Information | |||||||||
| NPI: | 1558656348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COKER | ||||||||
| FirstName: | KARAH | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 MEDICAL CIRCLE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ATHENS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757515036 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1505 STATE HIGHWAY 19 S | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757518950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036751725 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | P0566 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 324383402 | 05 | TX | MEDICAID | 1M2725 | 01 | TX | MEDICARE | OTHER |