Provider Demographics
NPI:1801552518
Name:BELISSARY, KAREN B
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:B
Last Name:BELISSARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W JODY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2031
Mailing Address - Country:US
Mailing Address - Phone:843-629-0103
Mailing Address - Fax:
Practice Address - Street 1:1222 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3322
Practice Address - Country:US
Practice Address - Phone:843-921-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCW87742SC1Medicaid