Individual provider Active NPI

Courtney Gayle Abernathy, PA-C

  • Medical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1750716809
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2306 Issued in OK
Practice address
717 S Houston Ave Ste 304
Tulsa, OK 74127-9023
Phone
(918) 382-5064
Fax
(918) 382-3589
NPI assigned
Sep 9, 2013
Last updated
Jan 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2306 OK Primary

Addresses

Primary practice location

717 S Houston Ave Ste 304
Tulsa, OK 74127-9023

Mailing address

5310 E 31St St FL 13
Tulsa, OK 74135-5018
Phone (918) 561-5701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141022001871 OK Practitioner - Physician Assistant 6608097332 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2306OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oklahoma State University CurrentSince Oct 30, 2021 Accepting new patients

Locations

1705 E 19th St
Ste 600
Tulsa, OK 74104
Phone (918) 742-8847

5310 E 31st St
Ste 13
Tulsa, OK 74135
Phone (918) 561-5701

717 S Houston Ave
Ste 304
Tulsa, OK 74127
Phone (918) 382-3535

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1750716809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 E 31ST ST FL 13",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741355018",
            "telephone_number": "918-561-5701",
            "fax_number": "918-561-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 S HOUSTON AVE STE 304",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741279023",
            "telephone_number": "918-382-5064",
            "fax_number": "918-382-3589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABERNATHY",
        "first_name": "COURTNEY",
        "middle_name": "GAYLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-09",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.