Provider Demographics
NPI:1497869747
Name:WAHNEE, KARI K (PA-C)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:K
Last Name:WAHNEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 2 BOX 246
Mailing Address - Street 2:BLACKHAWK HEALTH CENTER
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079
Mailing Address - Country:US
Mailing Address - Phone:918-968-9531
Mailing Address - Fax:918-968-4207
Practice Address - Street 1:1305 W CHEROKEE
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052
Practice Address - Country:US
Practice Address - Phone:405-756-1404
Practice Address - Fax:918-968-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK777363A00000X
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS76932Medicare UPIN
OK100107690CMedicare ID - Type Unspecified