Basic Information
| Provider Information | |||||||||
| NPI: | 1831137454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIELSON | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | LANETTE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828854007 | ||||||||
| FaxNumber: | 6828854004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | H7800 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 136928209 | 05 | TX | MEDICAID | 136928207 | 05 | TX | MEDICAID | 136928210 | 05 | TX | MEDICAID | 136928201 | 05 | TX | MEDICAID | 136928202 | 05 | TX | MEDICAID | 136928203 | 05 | TX | MEDICAID | 136928211 | 05 | TX | MEDICAID | 8R1514 | 01 | TX | BLUE CROSS OF TEXAS | OTHER | 136928212 | 05 | TX | MEDICAID |