Provider Demographics
NPI:1821861279
Name:GAINES, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-0061
Mailing Address - Country:US
Mailing Address - Phone:405-403-2668
Mailing Address - Fax:
Practice Address - Street 1:3619 NE 30TH ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:OK
Practice Address - Zip Code:73121-4029
Practice Address - Country:US
Practice Address - Phone:405-403-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator