Individual
KAREN LAVONNE FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
727 PORTSMOUTH AVENUE, BRISTOL, VA 24201
(276) 210-5051
Mailing address
727 PORTSMOUTH AVENUE, BRISTOL, VA 24201
(276) 210-5051
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0454187013
—
VA
Enumeration date
01/17/2018
Last updated
01/17/2018
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