Provider Demographics
NPI:1841231495
Name:PICCIONE, JOSEPH J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:PICCIONE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7301 E 93RD PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5463
Mailing Address - Country:US
Mailing Address - Phone:918-488-8948
Mailing Address - Fax:
Practice Address - Street 1:1541 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-4610
Practice Address - Country:US
Practice Address - Phone:918-838-3510
Practice Address - Fax:800-398-2067
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1126363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1126OtherOKLAHOMA MEDICAL LICENSE
OK43130OtherOBNDD
OK43130OtherOBNDD
OKMP2485248OtherDEA