Provider Demographics
NPI:1346232394
Name:MCKENNA, JOSEPH CARNELIUS (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CARNELIUS
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720276
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4208
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:1414 N KENNEDY AVE
Practice Address - Street 2:STE 105
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-4700
Practice Address - Country:US
Practice Address - Phone:405-275-1999
Practice Address - Fax:405-275-2114
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK12726207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17680Medicare UPIN