Provider Demographics
NPI:1720514219
Name:JOHANNES, KARINA MARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:MARIA
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4626
Mailing Address - Country:US
Mailing Address - Phone:918-748-8024
Mailing Address - Fax:918-748-8249
Practice Address - Street 1:1430 TERRACE DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-8024
Practice Address - Fax:918-748-8249
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA 2783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant