Provider Demographics
NPI:1871863712
Name:ROCHESTER, KAY B (PA-C)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:B
Last Name:ROCHESTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SE 4TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7329
Mailing Address - Country:US
Mailing Address - Phone:405-799-7400
Mailing Address - Fax:
Practice Address - Street 1:1400 SE 4TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7329
Practice Address - Country:US
Practice Address - Phone:405-799-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363AM0700X
OK2081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical