Provider Demographics
NPI:1053543025
Name:ADDAIR, KAREN P (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:P
Last Name:ADDAIR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:PREMIER
Mailing Address - State:WV
Mailing Address - Zip Code:24878-0219
Mailing Address - Country:US
Mailing Address - Phone:304-436-8323
Mailing Address - Fax:
Practice Address - Street 1:15237 COAL HERITAGE ROAD/US-52 NORTH
Practice Address - Street 2:HONEYCAMP/247
Practice Address - City:RODERFIELD
Practice Address - State:WV
Practice Address - Zip Code:24881
Practice Address - Country:US
Practice Address - Phone:304-436-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019568Medicaid
WV3810019568Medicaid
WVNP31971Medicare PIN
WV2034442Medicare PIN
WV2034441Medicare PIN