Provider Demographics
NPI:1003084781
Name:LEBEAU, CATHLEEN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ELIZABETH
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8001 S I 35 SERVICE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73149-2906
Mailing Address - Country:US
Mailing Address - Phone:405-600-6909
Mailing Address - Fax:405-600-6978
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-307-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200161510AMedicaid