Provider Demographics
NPI:1164414132
Name:YOZZO, MELODY J (PA C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:J
Last Name:YOZZO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:JEAN
Other - Last Name:SOKELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3614
Mailing Address - Fax:918-660-3611
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:STE 2G12
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2512
Practice Address - Country:US
Practice Address - Phone:918-660-3614
Practice Address - Fax:918-660-3611
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant