Provider Demographics
NPI:1053009688
Name:MIELE, KAREN NEIDICH (FNP-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:NEIDICH
Last Name:MIELE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:VALERIE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:10300 N CENTRAL EXPY STE 355
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2283
Mailing Address - Country:US
Mailing Address - Phone:214-503-7700
Mailing Address - Fax:
Practice Address - Street 1:10300 N CENTRAL EXPY STE 355
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2283
Practice Address - Country:US
Practice Address - Phone:214-503-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1117772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner