Individual provider Active NPI

Karen Marie Dyer, RN,CCM

  • Registered Nurse
  • Lawrenceville, GA
National Provider Identifier
1861897647
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN215362 Issued in GA
Practice address
1219 Pughes Creek Way
Lawrenceville, GA 30045-5473
Phone
(678) 491-1085
Fax
(770) 710-0653
NPI assigned
Oct 23, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN215362 GA Primary
Registered Nurse 163W00000X 061092 MO
Case Management Registered Nurse 163WC0400X RN215362 GA
Home Health Registered Nurse 163WH0200X RN215362 GA
Nutrition Support Registered Nurse 163WN1003X RN215362 GA
Child & Adolescent Psychiatric/Mental Health Registered Nurse 163WP0807X RN215362 GA
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X RN215362 GA
Rehabilitation Registered Nurse 163WR0400X RN215362 GA
Occupational Health Registered Nurse 163WX0106X RN215362 GA

Addresses

Primary practice location

1219 Pughes Creek Way
Lawrenceville, GA 30045-5473

Mailing address

1219 Pughes Creek Way
Lawrenceville, GA 30045-5473
Phone (678) 491-1085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
061092MOMDRegistered Nurse
RN215362GAMDNutrition Support Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414022400000",
    "number": "1861897647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 PUGHES CREEK WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300455473",
            "telephone_number": "678-491-1085",
            "fax_number": "770-710-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 PUGHES CREEK WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300455473",
            "telephone_number": "678-491-1085",
            "fax_number": "770-710-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYER",
        "first_name": "KAREN",
        "middle_name": "MARIE",
        "credential": "RN,CCM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-23",
        "last_updated": "2014-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN215362",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "061092",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        },
        {
            "code": "163WN1003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nutrition Support",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        },
        {
            "code": "163WX0106X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Occupational Health",
            "state": "GA",
            "license": "RN215362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.