Provider Demographics
NPI:1811008337
Name:PRASSADA, YOLANDA MARIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:MARIA
Last Name:PRASSADA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:MARIA
Other - Last Name:ESPEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-657-3825
Mailing Address - Fax:405-657-3824
Practice Address - Street 1:4833 INTEGRIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-657-3825
Practice Address - Fax:405-657-3824
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1762363A00000X, 363A00000X
IA001503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200247620AMedicaid
NE276880Medicare ID - Type Unspecified
IAI10433Medicare ID - Type Unspecified
OK200247620AMedicaid