Provider Demographics
NPI:1396739264
Name:HABBEN, LEE ANN (PAC)
Entity type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:HABBEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 N SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3700
Mailing Address - Country:US
Mailing Address - Phone:918-342-2622
Mailing Address - Fax:918-342-2641
Practice Address - Street 1:2990 N SIOUX AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3700
Practice Address - Country:US
Practice Address - Phone:918-342-2622
Practice Address - Fax:918-342-2641
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243521102OtherCMS PROVIDER NUMBER
OK27022OtherOK ST BUREAU OF NARCOTICS
OK100095320BMedicaid
OK1600763Medicaid
OK1600763Medicaid
OKS85607Medicare UPIN
OK243521102OtherCMS PROVIDER NUMBER