Provider Demographics
NPI:1720383656
Name:MAYHUE, MEGAN L (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:L
Last Name:MAYHUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10011 S YALE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6041
Mailing Address - Country:US
Mailing Address - Phone:918-299-5151
Mailing Address - Fax:918-299-2171
Practice Address - Street 1:10011 S YALE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-6041
Practice Address - Country:US
Practice Address - Phone:918-299-5151
Practice Address - Fax:918-299-2171
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1979363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical