Provider Demographics
NPI:1851144208
Name:WHITTEN, KARLEIGH PAIGE
Entity Type:Individual
Prefix:
First Name:KARLEIGH
Middle Name:PAIGE
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLEIGH
Other - Middle Name:PAIGE
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:988 RIVER XING
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-1039
Mailing Address - Country:US
Mailing Address - Phone:918-616-3140
Mailing Address - Fax:
Practice Address - Street 1:220 W 71ST ST STE 2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2011
Practice Address - Country:US
Practice Address - Phone:918-584-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant