Provider Demographics
NPI:1700150695
Name:JERSEY, KAREN MARIE (NP-C)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARIE
Last Name:JERSEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:JERSEY
Other - Last Name:WILLUHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 VAL SERENO DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6919
Mailing Address - Country:US
Mailing Address - Phone:760-809-5511
Mailing Address - Fax:
Practice Address - Street 1:MURPHY CANYON ROAD
Practice Address - Street 2:3914 MURPHY CANYON ROAD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-9212
Practice Address - Country:US
Practice Address - Phone:858-751-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21684363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21684OtherNURSE PRACTITIONER LICENSE