Provider Demographics
NPI:1376016741
Name:CHRISTY, SAMANTHA (PA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 CEDAR LAKE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7815
Mailing Address - Country:US
Mailing Address - Phone:405-445-1210
Mailing Address - Fax:
Practice Address - Street 1:6744 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2702
Practice Address - Country:US
Practice Address - Phone:580-536-9355
Practice Address - Fax:844-640-3975
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant