START YOUR OKIPA MEMBERSHIP (PA) Membership Type Individual Group Corporate Provider License PA NP CRNP APRN FND-P Other First Name Middle Initial Last Name Provider Specialty Allergy & Immunology Anesthesiology Cardiology Clinical Research Dermatology Ear, Nose and Throat Endocrinology Family Medicine Gastroenterology General Surgery Geriatrics Independent Lab Draw Station Infusion Services Internal Medicine Interventional Radiology Nephrology Neurological Surgery Neurology Nutrional Therapy Obstetrics & Gynecology Oncology Ophthalmology Orthopedics Otolaryngology Pain Management Palliative Medicine and Hospice Pathology Pediatrics Physical Medicine & Rehabilitation Plastic Surgery Psychiatry Radiology Rheumatology Sleep Medicine Urology Weight Loss FND-P Other Cell Phone Practice Phone Email Practice Name Address City State Zip Years in Practice 1–3 4–7 8–12 12+ Practice Contact First Name Practice Contact Last Name Practice Contact Title Practice Contact Office Phone Practice Contact Cell Phone Practice Contact Email Communication Preference Text Cell Office Phone Email Website chat Through Practice Contact Person Practice Pain Points (select all that apply) Benefits Billing and Accounts Receivable Contracts Education Insurance Participation Insurance Reimbursement Managing Overhead Expenses Networking Practice Growth Practice Staffing Referrals Wealth Management I agree to the Terms and Conditions of Membership. Submit & Go Pay Now
