Provider Demographics
NPI:1285256883
Name:ROCHESTER, CORTNEY RANAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CORTNEY
Middle Name:RANAE
Last Name:ROCHESTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:BOOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5323 S 65TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-8213
Mailing Address - Country:US
Mailing Address - Phone:918-340-5400
Mailing Address - Fax:539-444-0148
Practice Address - Street 1:817 S ELM PL STE 106
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5369
Practice Address - Country:US
Practice Address - Phone:918-928-5437
Practice Address - Fax:918-615-9352
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily