Provider Demographics
NPI:1003955170
Name:EDMINSTEN, JAMIE TENILLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:TENILLE
Last Name:EDMINSTEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-755-1930
Mailing Address - Fax:
Practice Address - Street 1:3650 W ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-364-2666
Practice Address - Fax:405-364-9627
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA1602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200105600AMedicaid
OK200105600AMedicaid