Provider Demographics
NPI:1053303677
Name:FIELDER, CATHY JUDEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:JUDEAN
Last Name:FIELDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 SOUTH 4290 ROAD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-5012
Mailing Address - Country:US
Mailing Address - Phone:918-636-4980
Mailing Address - Fax:
Practice Address - Street 1:202 E GALER AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-4422
Practice Address - Country:US
Practice Address - Phone:918-273-0192
Practice Address - Fax:918-273-0194
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP59456Medicare UPIN