Provider Demographics
NPI:1245788231
Name:YINGLING, JILLIAN (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:YINGLING
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:825 NE 10TH ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5417
Mailing Address - Country:US
Mailing Address - Phone:405-271-2663
Mailing Address - Fax:
Practice Address - Street 1:825 NE 10TH ST STE 1C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00408200363A00000X
OH50.006479RX363A00000X
NY020018363A00000X
OK4615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant