Healthcare Provider Details

I. General information

NPI: 1366118978
Provider Name (Legal Business Name): MICHIE Y OKURA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 11/05/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 LOUISIANA DRIVE DYESS AFB
ABILENE TX
79607-1367
US

IV. Provider business mailing address

697 LOUISIANA DRIVE DYESS AIR FORCE BASE
ABILENE TX
79607-1367
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-7251
  • Fax:
Mailing address:
  • Phone: 808-492-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: