Provider Demographics
NPI:1619959814
Name:LOFTIS, MELISSA ANN (PAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:CRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:7301 N COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6636
Mailing Address - Country:US
Mailing Address - Phone:405-728-2100
Mailing Address - Fax:405-728-2244
Practice Address - Street 1:7301 N COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-6636
Practice Address - Country:US
Practice Address - Phone:405-728-2100
Practice Address - Fax:405-728-2244
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48698Medicare UPIN
OK248323901Medicare ID - Type Unspecified