Provider Demographics
NPI:1639411630
Name:MEIWES, AMBER MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:MEIWES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14024 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1006
Mailing Address - Country:US
Mailing Address - Phone:405-419-8465
Mailing Address - Fax:405-419-7745
Practice Address - Street 1:63 GOODER SIMPSON BLVD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9215
Practice Address - Country:US
Practice Address - Phone:405-373-0380
Practice Address - Fax:405-373-0457
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK.Other.