Provider Demographics
NPI:1215719612
Name:STARCHMAN, ISABELLA RENE (PA-C)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:RENE
Last Name:STARCHMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4524
Mailing Address - Country:US
Mailing Address - Phone:405-588-2301
Mailing Address - Fax:
Practice Address - Street 1:1100 N LINDSAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5410
Practice Address - Country:US
Practice Address - Phone:405-271-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty