Individual
KAREN CONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1691 GALISTEO ST, SUITE C, SANTA FE, NM 87505-4780
(505) 983-5631
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2014-0057
NM
363AM0700X
Medical Physician Assistant
PA2014-0057
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2P2326
MEDICARE PTAN
NM
05
—
7638710
—
NM
Enumeration date
12/04/2014
Last updated
10/30/2023
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