Provider Demographics
NPI:1255589941
Name:MANSALIS, KATHERINE A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:MANSALIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:BAERWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-951-2855
Mailing Address - Fax:405-951-2858
Practice Address - Street 1:3500 NW 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4517
Practice Address - Country:US
Practice Address - Phone:405-951-2855
Practice Address - Fax:405-951-2858
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091073A207Q00000X
OK33463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine