Provider Demographics
NPI:1871585968
Name:ATKINSON, KAREN LYNN (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:GLOSSBRENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:545 B ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2605
Mailing Address - Country:US
Mailing Address - Phone:559-423-5312
Mailing Address - Fax:
Practice Address - Street 1:1025 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3722
Practice Address - Country:US
Practice Address - Phone:559-583-2254
Practice Address - Fax:559-589-2065
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18404363AM0700X
AZ2768363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ518516Medicaid
AZZ73523Medicare ID - Type Unspecified
AZP85107Medicare UPIN