Provider Demographics
NPI:1194459321
Name:PACE, COURTNEY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-5110
Mailing Address - Country:US
Mailing Address - Phone:918-935-9523
Mailing Address - Fax:
Practice Address - Street 1:ASCENSION MEDICAL GROUP ST. JOHN NEUROLOGY & STROKE
Practice Address - Street 2:2000 S WHEELING AVE STE 701
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208821363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care