Provider Demographics
NPI:1578806659
Name:PAUL, EDGAR (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S BELMONT AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6315
Mailing Address - Country:US
Mailing Address - Phone:918-756-8371
Mailing Address - Fax:918-758-3437
Practice Address - Street 1:1101 S BELMONT AVE
Practice Address - Street 2:STE 205
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6315
Practice Address - Country:US
Practice Address - Phone:918-756-8371
Practice Address - Fax:918-758-3437
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88212363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics