Provider Demographics
NPI:1760487243
Name:BUTNER, TRICIA LEE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LEE
Last Name:BUTNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LEE
Other - Last Name:COLCLAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:405-972-7239
Mailing Address - Fax:405-753-1863
Practice Address - Street 1:2403 W WRANGLER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868
Practice Address - Country:US
Practice Address - Phone:405-382-4939
Practice Address - Fax:405-242-5928
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095680CMedicaid
OK100095680CMedicaid