Provider Demographics
NPI:1326531690
Name:WILLIAMS, KAREN LARISSA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LARISSA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LARISSA
Other - Last Name:MANAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13408 S 20TH CT
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-1029
Mailing Address - Country:US
Mailing Address - Phone:904-735-7749
Mailing Address - Fax:
Practice Address - Street 1:3100 S ELM PL STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7950
Practice Address - Country:US
Practice Address - Phone:918-884-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109297363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care