Healthcare Provider Details

I. General information

NPI: 1487626453
Provider Name (Legal Business Name): CHRISTIE LEE HARRISON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S ST LOUIS AVE
TULSA OK
74120
US

IV. Provider business mailing address

PO BOX 268838
OKLAHOMA CITY OK
73126-8838
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4600
  • Fax: 918-619-4601
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number402
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: