Provider Demographics
NPI:1730327446
Name:MCKINNON, GAYLE MARIE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MARIE
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6839 S CANTON AVE,
Mailing Address - Street 2:ASSOCIATED ANESTHESIOLOGISTS INC
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126
Mailing Address - Country:US
Mailing Address - Phone:918-494-0612
Mailing Address - Fax:
Practice Address - Street 1:10501 EAST 91ST STREET SOUTH
Practice Address - Street 2:SAINT FRANCIS SOUTH
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-307-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74313367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400077262Medicare PIN