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Individual

PATRICE J HARRISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, CCC

Contact information

Practice address
1401 E VAN BUREN AVE, MCALESTER, OK 74501-4245
(918) 426-0240
(918) 423-4051
Mailing address
PO BOX 908, MCALESTER, OK 74502-0908
(918) 426-0240
(918) 423-4051

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
59
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0166707
UMWA
OK
01
731310891006
UNICARE
OK
01
731310891028
TRICARE SOUTH
OK
01
74502A045
CHAMPUS (WPS)
OK
01
D35047
STERLING OPTION 1
OK
Enumeration date
04/11/2006
Last updated
04/14/2008
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