Provider Demographics
NPI:1578854931
Name:CLICK, DEZIRAY SWING (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEZIRAY
Middle Name:SWING
Last Name:CLICK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:16805 KINROSS CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8436
Mailing Address - Country:US
Mailing Address - Phone:405-408-3878
Mailing Address - Fax:405-285-0303
Practice Address - Street 1:16805 KINROSS CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8436
Practice Address - Country:US
Practice Address - Phone:405-408-3878
Practice Address - Fax:405-285-0303
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant