Provider Demographics
NPI:1265469092
Name:MCCLATCHEY, ROBBIE (PA)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:MCCLATCHEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6190 WAGON WHEEL CIR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-8126
Mailing Address - Country:US
Mailing Address - Phone:405-376-9315
Mailing Address - Fax:405-634-7577
Practice Address - Street 1:4525 S KLEIN AVE STE 1000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3839
Practice Address - Country:US
Practice Address - Phone:405-604-9595
Practice Address - Fax:405-634-7577
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKPA624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S24885Medicare UPIN