Provider Demographics
NPI:1336585660
Name:YARBOROUGH, ERIN COLEMAN (PA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:COLEMAN
Last Name:YARBOROUGH
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 1:416 W 15TH ST
Mailing Address - Street 2:BLDG 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-471-6611
Mailing Address - Fax:405-471-5858
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:BLDG 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-471-6611
Practice Address - Fax:405-471-5858
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08413363A00000X
OK2669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310109YKPWMedicare PIN