Healthcare Provider Details

I. General information

NPI: 1962558957
Provider Name (Legal Business Name): ALBERT OKINE PA-C., M.S.P.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 SOUTHERN HILLS DR
SIOUX CITY IA
51106-4736
US

IV. Provider business mailing address

3549 SOUTHERN HILLS DR
SIOUX CITY IA
51106-4736
US

V. Phone/Fax

Practice location:
  • Phone: 712-274-6729
  • Fax: 712-274-6744
Mailing address:
  • Phone: 712-274-6729
  • Fax: 712-274-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number001776
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001776
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: