Provider Demographics
NPI:1760564363
Name:MYER, PATRICK SEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:SEAN
Last Name:MYER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 MORNING STAR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6574
Mailing Address - Country:US
Mailing Address - Phone:405-696-6500
Mailing Address - Fax:
Practice Address - Street 1:1111 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2609
Practice Address - Country:US
Practice Address - Phone:405-272-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166931367500000X
GARN205132367500000X
OK110507367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered