Provider Demographics
NPI:1497012900
Name:ARTISAN HEALTH CLINIC, PLLC
Entity Type:Organization
Organization Name:ARTISAN HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORKRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-533-2844
Mailing Address - Street 1:1413 S WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-6957
Mailing Address - Country:US
Mailing Address - Phone:405-533-2844
Mailing Address - Fax:
Practice Address - Street 1:1413 S WESTERN RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-6957
Practice Address - Country:US
Practice Address - Phone:405-533-2844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK167432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty