| NPI | 1578159729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Senior Credentialing Specialist 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207Y00000X Otolaryngology | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |