Provider Demographics
NPI:1679683221
Name:EATON, JULYE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULYE
Middle Name:MARIE
Last Name:EATON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULYE
Other - Middle Name:MARIE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3224 SW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4548
Mailing Address - Country:US
Mailing Address - Phone:405-759-3880
Mailing Address - Fax:405-759-3882
Practice Address - Street 1:3224 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4548
Practice Address - Country:US
Practice Address - Phone:405-759-3880
Practice Address - Fax:405-759-3882
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200205560AMedicaid
OK200205560AMedicaid