Provider Demographics
NPI:1851359756
Name:MITCHELL-HUBER, LORA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:JEAN
Last Name:MITCHELL-HUBER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-488-6045
Mailing Address - Fax:918-251-9339
Practice Address - Street 1:7858 S OLYMPIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1857
Practice Address - Country:US
Practice Address - Phone:918-986-9250
Practice Address - Fax:918-986-9205
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK890363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00164911OtherRR MEDICARE
OK970018309OtherRR MEDICARE
OK100174170AMedicaid
OK241412208Medicare ID - Type Unspecified
OK970018309OtherRR MEDICARE
OKS44852Medicare UPIN