Provider Demographics
NPI:1902919756
Name:PLUNKETT, KAREN W (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:W
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUNSET DR STE O
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-227-0998
Mailing Address - Fax:662-227-0984
Practice Address - Street 1:1300 SUNSET DR STE O
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-227-0998
Practice Address - Fax:662-227-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04570579Medicaid
MS04570579Medicaid
MSC03093Medicare ID - Type Unspecified