Provider Demographics
NPI:1518162528
Name:MORGAN-VANDERLICK, KAREN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:MORGAN-VANDERLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:JANETTE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1916W C ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2367
Mailing Address - Country:US
Mailing Address - Phone:918-701-2055
Mailing Address - Fax:918-701-2056
Practice Address - Street 1:1916W C ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2367
Practice Address - Country:US
Practice Address - Phone:918-701-2055
Practice Address - Fax:918-701-2056
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25659207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDA8285OtherMEDICARE RAIL ROAD
OK200211780AMedicaid
OKOK404363Medicare PIN
OK200211780AMedicaid