Basic Information
Provider Information
NPI: 1962754218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MESSICK
FirstName: ALINA
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5310 E 31ST ST FL 13
Address2:  
City: TULSA
State: OK
PostalCode: 741355018
CountryCode: US
TelephoneNumber: 9185615701
FaxNumber: 9185611173
Practice Location
Address1: 5310 E 31ST ST FL 11 STE 1102
Address2:  
City: TULSA
State: OK
PostalCode: 741355018
CountryCode: US
TelephoneNumber: 9185611890
FaxNumber: 9185611889
Other Information
ProviderEnumerationDate: 10/11/2012
LastUpdateDate: 03/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000XC0004899MDY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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