Healthcare Provider Details

I. General information

NPI: 1164406682
Provider Name (Legal Business Name): MARY BATTOE GELLNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY K. BATTOE PA-C

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROCKEFELLER DR
MUSKOGEE OK
74401-5075
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-684-3374
  • Fax: 918-681-6814
Mailing address:
  • Phone: 918-488-6045
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: