Provider Demographics
NPI:1578515086
Name:REDINGTON, JULIE M (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:REDINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:BENANZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6151 S YALE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1907
Mailing Address - Country:US
Mailing Address - Phone:918-494-9494
Mailing Address - Fax:918-494-9459
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-494-9494
Practice Address - Fax:918-494-9459
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1399363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200052240AMedicaid