Provider Demographics
NPI:1437152774
Name:MASON, ATHENA C (DO)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ATHENA
Other - Middle Name:C
Other - Last Name:RICHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8210
Practice Address - Street 1:2950 S ELM PL STE 160
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7816
Practice Address - Country:US
Practice Address - Phone:981-455-7777
Practice Address - Fax:918-455-8105
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113580AMedicaid