Provider Demographics
NPI:1750310736
Name:WAHKINNEY, REBEKAH (PHD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:WAHKINNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33708 POST OFFICE NCK
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-3407
Mailing Address - Country:US
Mailing Address - Phone:405-878-3432
Mailing Address - Fax:888-570-2459
Practice Address - Street 1:3200 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-5014
Practice Address - Country:US
Practice Address - Phone:405-878-3432
Practice Address - Fax:888-570-2459
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
OK952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200021980AMedicaid