Provider Demographics
NPI:1285086744
Name:CATRINA BOURNE, PLLC
Entity type:Organization
Organization Name:CATRINA BOURNE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:FELICE
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-919-3332
Mailing Address - Street 1:609 STONEMILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5770
Mailing Address - Country:US
Mailing Address - Phone:405-919-3332
Mailing Address - Fax:
Practice Address - Street 1:1820 COMMONS CIR
Practice Address - Street 2:SUITE A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9518
Practice Address - Country:US
Practice Address - Phone:405-265-2778
Practice Address - Fax:405-494-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty