Provider Demographics
NPI:1922126648
Name:TANKSLEY, PATTI ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:ELIZABETH
Last Name:TANKSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3041
Mailing Address - Country:US
Mailing Address - Phone:405-376-3605
Mailing Address - Fax:405-376-3605
Practice Address - Street 1:711 W JUNIPER DR
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3041
Practice Address - Country:US
Practice Address - Phone:405-376-3605
Practice Address - Fax:405-376-3605
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle