Provider Demographics
NPI:1275797540
Name:TATE, PATRICIANN M (PAC)
Entity Type:Individual
Prefix:
First Name:PATRICIANN
Middle Name:M
Last Name:TATE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 S YALE AVE
Mailing Address - Street 2:SUITE 1305
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1907
Mailing Address - Country:US
Mailing Address - Phone:918-494-9494
Mailing Address - Fax:918-494-9459
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:SUITE 1305
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-494-9494
Practice Address - Fax:918-494-9459
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant