Provider Demographics
NPI:1083952485
Name:MASHBURN, WHITNEY T (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:T
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:T
Other - Last Name:KRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1616 S. KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3651
Mailing Address - Country:US
Mailing Address - Phone:405-285-8823
Mailing Address - Fax:405-285-8824
Practice Address - Street 1:1616 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3651
Practice Address - Country:US
Practice Address - Phone:405-285-8823
Practice Address - Fax:405-285-8824
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2231OtherSTATE LICENSE