Healthcare Provider Details

I. General information

NPI: 1023576709
Provider Name (Legal Business Name): MELISSA PATTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 24TH AVE NW STE 110
NORMAN OK
73069-6556
US

IV. Provider business mailing address

7107 S YALE AVE # 160
TULSA OK
74136-6308
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-5306
  • Fax: 405-310-4934
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: