Healthcare Provider Details

I. General information

NPI: 1235898248
Provider Name (Legal Business Name): LORI PATRICK CPC, CPMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 E SKELLY DR
TULSA OK
74135-6106
US

IV. Provider business mailing address

1916 E PRINCETON ST
BROKEN ARROW OK
74012-2097
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-7216
  • Fax:
Mailing address:
  • Phone: 918-645-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: