Provider Demographics
NPI:1194374116
Name:PRICE, COURTNEY LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LAUREN
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LAUREN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 268938
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8938
Mailing Address - Country:US
Mailing Address - Phone:405-752-9600
Mailing Address - Fax:405-752-9650
Practice Address - Street 1:13921 N MERIDIAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1106
Practice Address - Country:US
Practice Address - Phone:405-752-9600
Practice Address - Fax:405-752-9650
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant