Michelle L Bourne, PA-C
Individual provider Active NPI Physician Assistant · Norman, OK
NPI 1124027263 · NPPES record last updated Feb 12, 2014
Key facts
- NPI
- 1124027263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1164 (OK)
- Practice address
- 2080 Hwy 9 West
Norman, OK 73072 - Phone
- (405) 322-6800
- NPI assigned
- Jul 20, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1164 | NM | MD | Occupational Therapist |
| 1164 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integris Ambulatory Care Corporation | Past | Accepting new patients | |
| Integris Rural Health Inc | Past | Accepting new patients | |
| NRHS West Family Medicine Associates | Past | Accepting new patients | |
| Marshall County Hma LLC | Past | Accepting new patients | |
| Marshall County HMPN, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1164 | OK | Yes |
Addresses
Primary practice location
2080 Hwy 9 West
Norman, OK 73072
Mailing address
4008 Wood Castle St
Norman, OK 73072-1795
Phone (405) 919-8490
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100138520A | Medicaid | OK |
Other names
- Michelle L Trumble
Other providers in Norman, OK
- Sydney Lorraine Boothe
- Steven Franklin Borden
- Chad E. Borin
- Vicki Lynn Borycki
- Katie Bottoms
- Cassandra Bournival
- Elissa Brielle Boutharouit
- Heather J Bowen
- Jennifer Kay Bowen
- Philip Don Bowen
All providers in Norman, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.