Provider Demographics
NPI:1740548551
Name:KARISSA MISNER PLLC
Entity type:Organization
Organization Name:KARISSA MISNER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-894-9162
Mailing Address - Street 1:1216 E KENOSHA ST
Mailing Address - Street 2:PMB 326
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2007
Mailing Address - Country:US
Mailing Address - Phone:918-615-6581
Mailing Address - Fax:918-893-1242
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:REHABILITATION UNIT
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-684-2522
Practice Address - Fax:918-684-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4643208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200474240AMedicaid
OK280829Medicare PIN
OK200474240AMedicaid