Provider Demographics
NPI:1356904502
Name:GENO, KARA (APN)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:GENO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8063 BURGUNDY CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1290
Mailing Address - Country:US
Mailing Address - Phone:423-361-2288
Mailing Address - Fax:
Practice Address - Street 1:74785 US HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7129
Practice Address - Country:US
Practice Address - Phone:760-776-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25754363LF0000X
NC5021288363LF0000X
KS53-83666-092363LF0000X
CA95033665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048300Medicaid