Provider Demographics
NPI:1467685560
Name:MAYHEW, CHARITY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANN
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 HEFNER POINTE DR STE 505
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5006
Mailing Address - Country:US
Mailing Address - Phone:405-246-0391
Mailing Address - Fax:405-246-0391
Practice Address - Street 1:10900 HEFNER POINTE DR STE 505
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5006
Practice Address - Country:US
Practice Address - Phone:405-246-0391
Practice Address - Fax:405-246-0392
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1801363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200273220AMedicaid