Provider Demographics
NPI:1063566818
Name:MISNER, KARISSA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:MARIE
Last Name:MISNER
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4643208100000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200215510AMedicaid
OK200215510AMedicaid
OK280830YRBLMedicare PIN