Karissa McNeal Wagenblatt, APRN-CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

205796 Issued in OK

Practice address

10506 S Memorial Dr
Tulsa, OK 74133-6914

Phone

(918) 369-3200

Fax

(918) 369-3209

NPI assigned

Oct 7, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwagenblatt29995@direct.saintfrancis.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1972265981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE STE 1200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363333",
            "telephone_number": "918-488-6653",
            "fax_number": "918-488-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10506 S MEMORIAL DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336914",
            "telephone_number": "918-369-3200",
            "fax_number": "918-369-3209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENBLATT",
        "first_name": "KARISSA",
        "middle_name": "MCNEAL",
        "credential": "APRN-CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-07",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "205796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Wade
• Emma Wadley
• Darwin E Wadsworth Jr., O.D.
• Camille Lorraine Wafer
• Elisabeth Ann Wagenblast, LPN
• Benjamin Wagga
• Judy K Wagga
• Shelley Waggoner
• Wagner Family Chiropractic PC
• Jared Miller Wagner, PHARMD

• Family Nurse Practitioner in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.