Provider Demographics
NPI:1831346949
Name:HOMER, CAROL LE (PA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LE
Last Name:HOMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MAU
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:4300 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-752-3715
Mailing Address - Fax:405-936-5058
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-752-3715
Practice Address - Fax:405-936-5058
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05959363A00000X
OK2163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant