Healthcare Provider Details

I. General information

NPI: 1659696342
Provider Name (Legal Business Name): COURTNEY PATIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9312 NW 99TH CIR
YUKON OK
73099-8599
US

IV. Provider business mailing address

3433 NW 56TH ST SUITE 750
OKLAHOMA CITY OK
73112-4455
US

V. Phone/Fax

Practice location:
  • Phone: 405-650-3781
  • Fax: 405-945-4901
Mailing address:
  • Phone: 405-945-4900
  • Fax: 405-945-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1894
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: