Provider Demographics
NPI:1629052808
Name:COSTNER, PATRICIA A (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:COSTNER
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Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-481-4000
Mailing Address - Fax:918-491-5740
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-481-4000
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-05-06
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Provider Licenses
StateLicense IDTaxonomies
OK26072084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2438000302Medicare PIN
OKE45352Medicare UPIN