Provider Demographics
NPI:1073774279
Name:HALE, COURTNEY MARIE (APRN-FNP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MARIE
Last Name:HALE
Suffix:
Gender:F
Credentials:APRN-FNP
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Mailing Address - Street 1:1515 N HARVARD AVE
Mailing Address - Street 2:STE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-4957
Mailing Address - Country:US
Mailing Address - Phone:918-832-6049
Mailing Address - Fax:918-832-6055
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:ATTN: EMERGENCY DEPARTMENT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-3528
Practice Address - Fax:918-744-3529
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK77451363LF0000X
GA174976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200208240AMedicaid
OKOKA100272Medicare Oscar/Certification