Provider Demographics
NPI:1164446654
Name:WING, ARLYN GAIL (PAC)
Entity Type:Individual
Prefix:MR
First Name:ARLYN
Middle Name:GAIL
Last Name:WING
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-213-9781
Mailing Address - Fax:580-213-9782
Practice Address - Street 1:915 E GARRIOTT RD
Practice Address - Street 2:SUITE I
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-213-9781
Practice Address - Fax:580-213-9782
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-02-12
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Provider Licenses
StateLicense IDTaxonomies
OK584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100195380AMedicaid
OK242700504Medicare PIN
OK325709YKW9Medicare PIN