Provider Demographics
NPI:1487661245
Name:WILLIAMS, REBECCA R (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:530 N MONTE VISTA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4675
Mailing Address - Country:US
Mailing Address - Phone:580-436-7101
Mailing Address - Fax:580-436-4447
Practice Address - Street 1:4505 MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5004
Practice Address - Country:US
Practice Address - Phone:405-749-7099
Practice Address - Fax:405-216-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1290OtherPHYSICIAN ASSISTANTS