Provider Demographics
NPI:1518946326
Name:MEREDITH, MARGARET ELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLA
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36488 S HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-7438
Mailing Address - Country:US
Mailing Address - Phone:918-788-1881
Mailing Address - Fax:918-782-4266
Practice Address - Street 1:36488 S HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7438
Practice Address - Country:US
Practice Address - Phone:918-782-1881
Practice Address - Fax:918-782-4266
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP63997Medicare UPIN