Basic Information
| Provider Information | |||||||||
| NPI: | 1972651313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTON-NIELSEN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 601 HWY 110 N BAY 0 | ||||||||
| Address2: | |||||||||
| City: | WHITEHOUSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757913037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038392585 | ||||||||
| FaxNumber: | 9038393165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 12/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H6034 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 047364704 | 05 | TX | MEDICAID | 047364702 | 05 | TX | MEDICAID | TIN PLUS 001 | 01 | TX | TRICARE CANTON LOCATION | OTHER | 8BC403 | 01 | TX | BCBS OF TEXAS | OTHER | TIN PLUS 023 | 01 | TX | TRICARE WHITHOUSE LOCATION | OTHER | TIN PLUS 028 | 01 | TX | TRICARE LINDALE LOCATION | OTHER | TIN PLUS 042 | 01 | TX | TRICARE WOUND CARE LOCATION | OTHER | 8B9735 | 01 | TX | BCBS | OTHER |