Provider Demographics
NPI:1003884750
Name:PALMER, MARCIA R (PA)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:R
Last Name:PALMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2525 NW EXPRESSWAY
Mailing Address - Street 2:STE 610
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7251
Mailing Address - Country:US
Mailing Address - Phone:405-286-9465
Mailing Address - Fax:405-286-9462
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:405-713-4740
Practice Address - Fax:405-713-2974
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200011940AMedicaid
OK200011940AMedicaid