Provider Demographics
NPI:1609016898
Name:MORITZ, ERIN KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MORITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:STUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 W. BOISE CIRCLE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014
Mailing Address - Country:US
Mailing Address - Phone:918-307-0215
Mailing Address - Fax:918-250-7669
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE 335
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-307-0215
Practice Address - Fax:918-250-7669
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant