Healthcare Provider Details

I. General information

NPI: 1932403581
Provider Name (Legal Business Name): KATIE OWENS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PORTER DR
MIDDLEBURY VT
05753-8423
US

IV. Provider business mailing address

9228 S MINGO RD SUITE 200
TULSA OK
74133-5718
US

V. Phone/Fax

Practice location:
  • Phone: 802-382-3443
  • Fax: 802-388-5614
Mailing address:
  • Phone: 918-592-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAPA1946
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: