Provider Demographics
NPI:1780924084
Name:GREEN, KATRIN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATRIN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATRIN
Other - Middle Name:
Other - Last Name:LABORENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 NW 39TH EXPY
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2513
Mailing Address - Country:US
Mailing Address - Phone:405-789-6711
Mailing Address - Fax:405-349-5145
Practice Address - Street 1:6800 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2513
Practice Address - Country:US
Practice Address - Phone:405-789-6711
Practice Address - Fax:405-349-5145
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA2250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant