Basic Information
| Provider Information | |||||||||
| NPI: | 1740548551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KARISSA MISNER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1216 E KENOSHA ST | ||||||||
| Address2: | PMB 326 | ||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740122007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186156581 | ||||||||
| FaxNumber: | 9188931242 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 ROCKEFELLER DR | ||||||||
| Address2: | REHABILITATION UNIT | ||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744015075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186842522 | ||||||||
| FaxNumber: | 9186842493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2012 | ||||||||
| LastUpdateDate: | 12/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | MISNER | ||||||||
| AuthorizedOfficialFirstName: | KARISSA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9188949162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 4643 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 200474240A | 05 | OK | MEDICAID |