Provider Demographics
NPI:1659696342
Name:PATIN, COURTNEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:PATIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3433 NW 56TH ST
Mailing Address - Street 2:SUITE 750
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-945-4900
Mailing Address - Fax:405-945-4901
Practice Address - Street 1:9312 NW 99TH CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8599
Practice Address - Country:US
Practice Address - Phone:405-650-3781
Practice Address - Fax:405-945-4901
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant