Healthcare Provider Details

I. General information

NPI: 1295263838
Provider Name (Legal Business Name): ADRIAN NICOLE RATKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 910
TULSA OK
74136
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-502-3200
  • Fax: 918-502-3205
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 Number2802
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: