Provider Demographics
NPI:1841707387
Name:PANKOWSKY, KATIE (DNP, APRN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PANKOWSKY
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2101
Mailing Address - Country:US
Mailing Address - Phone:918-401-1002
Mailing Address - Fax:
Practice Address - Street 1:102 WEST CARL HUBBELL BLVD
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:OK
Practice Address - Zip Code:74855
Practice Address - Country:US
Practice Address - Phone:405-279-4281
Practice Address - Fax:918-493-3304
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF08170451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100277OtherOKLAHOMA BOARD OF NURSING, ADVANCED PRACTICE