Provider Demographics
NPI:1679030738
Name:JUENGEL, KACI BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:BROOKE
Last Name:JUENGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:BROOKE
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3301 NW 50TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5708
Mailing Address - Country:US
Mailing Address - Phone:405-947-0911
Mailing Address - Fax:405-947-1341
Practice Address - Street 1:3301 NW 50TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5708
Practice Address - Country:US
Practice Address - Phone:405-947-0911
Practice Address - Fax:405-947-1341
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant