Provider Demographics
NPI:1386319101
Name:HASTINGS, TAILOR (PA-C)
Entity type:Individual
Prefix:
First Name:TAILOR
Middle Name:
Last Name:HASTINGS
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 1:1128 S PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-5770
Mailing Address - Country:US
Mailing Address - Phone:918-327-0404
Mailing Address - Fax:
Practice Address - Street 1:9003 N GARNETT RD
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4495
Practice Address - Country:US
Practice Address - Phone:918-272-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant