Provider Demographics
NPI:1679846851
Name:KILLACKEY, KAREN ANN (RN, BSN, MS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:KILLACKEY
Suffix:
Gender:F
Credentials:RN, BSN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6725
Mailing Address - Country:US
Mailing Address - Phone:405-820-8204
Mailing Address - Fax:
Practice Address - Street 1:2716 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6725
Practice Address - Country:US
Practice Address - Phone:405-820-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25851163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse