Provider Demographics
NPI:1255625166
Name:ELLINGTON, PATRICIA DEARING
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DEARING
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATT
Other - Middle Name:
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:303 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4361
Mailing Address - Country:US
Mailing Address - Phone:918-429-4580
Mailing Address - Fax:918-420-5887
Practice Address - Street 1:111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-429-4580
Practice Address - Fax:918-420-5887
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health