Provider Demographics
NPI:1730172909
Name:TOMKY, KAREN JEANINE (MSN, FNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JEANINE
Last Name:TOMKY
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORDWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81063-1302
Mailing Address - Country:US
Mailing Address - Phone:719-267-3503
Mailing Address - Fax:719-267-4153
Practice Address - Street 1:319 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1302
Practice Address - Country:US
Practice Address - Phone:719-267-3503
Practice Address - Fax:719-267-4153
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54043 RXN, NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63253780Medicaid
CO63253780Medicaid