Provider Demographics
NPI:1215950894
Name:BARBOUR, KATHLEEN HATHORN (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HATHORN
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10512 ELMWOOD FOREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73151
Mailing Address - Country:US
Mailing Address - Phone:405-820-0870
Mailing Address - Fax:405-340-1555
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-3445
Practice Address - Fax:405-271-1405
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP98883Medicare UPIN
OK900522127Medicare ID - Type Unspecified