Provider Demographics
NPI:1497121289
Name:LAFFERTY, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:LAFFERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:306 TIMBERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-7144
Mailing Address - Country:US
Mailing Address - Phone:304-457-4423
Mailing Address - Fax:
Practice Address - Street 1:306 TIMBERLAND TRL
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-7144
Practice Address - Country:US
Practice Address - Phone:304-457-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV032172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV032OtherLICENSE