Provider Demographics
NPI:1902899818
Name:PRILL, KAREN S (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:PRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:J
Other - Last Name:PRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:271 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7455
Mailing Address - Country:US
Mailing Address - Phone:423-968-2311
Mailing Address - Fax:423-968-2312
Practice Address - Street 1:271 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7455
Practice Address - Country:US
Practice Address - Phone:423-968-2311
Practice Address - Fax:423-968-2312
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029304207RH0003X
VA0101055816207RH0003X
WI18353-875207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3812756Medicaid
VA900000024OtherTRAILBLAZERS MEDICARE
TN900001693OtherPALMETTTO RR MEDICARE
WI100087580Medicaid
VA900001693OtherPALMETTO RR MEDICARE
TN3812756Medicaid
VA900000024OtherTRAILBLAZERS MEDICARE
VA900001693OtherPALMETTO RR MEDICARE
TNF85426Medicare UPIN