Provider Demographics
NPI:1962824433
Name:CORBIN, LAURA ANN (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CORBIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-403-7065
Mailing Address - Fax:918-744-2946
Practice Address - Street 1:220 S ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3701
Practice Address - Country:US
Practice Address - Phone:918-403-7144
Practice Address - Fax:918-856-5561
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2024-12-04
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Provider Licenses
StateLicense IDTaxonomies
OK2357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant