Provider Demographics
NPI:1578992293
Name:SWEETIN-LEWIS, HILLARY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:JO
Last Name:SWEETIN-LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:JO
Other - Last Name:SWEETIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:286 NW BAY DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-3061
Mailing Address - Country:US
Mailing Address - Phone:918-470-3923
Mailing Address - Fax:
Practice Address - Street 1:620 ELM AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-4472
Practice Address - Country:US
Practice Address - Phone:405-325-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2850OtherOKLAHOMA STATE MEDICAL BOARD