Provider Demographics
NPI:1629060066
Name:MASON, CARLA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:MASON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant