Provider Demographics
NPI:1508160821
Name:KISSICK, KAREN LYNN (CASE MANAGER)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:KISSICK
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 E CHARTER OAK RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-9263
Mailing Address - Country:US
Mailing Address - Phone:405-282-4093
Mailing Address - Fax:866-941-8550
Practice Address - Street 1:4000 E CHARTER OAK RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-9263
Practice Address - Country:US
Practice Address - Phone:405-282-4093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200382030AMedicaid
OK300201OtherCERTIFIED BEHAVIORAL HEALTH CASE MANAGER, LEVEL CM II