Provider Demographics
NPI:1083038418
Name:PENTECOST, KATHARINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:PENTECOST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:IMPELLITIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 SL YOUNG BLVD
Mailing Address - Street 2:WP1310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-8001
Mailing Address - Fax:405-271-5892
Practice Address - Street 1:920 SL YOUNG BLVD
Practice Address - Street 2:WP1310
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-8001
Practice Address - Fax:405-271-5892
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant