Provider Demographics
NPI:1881661015
Name:FREELAND, ROBYN D (PA C)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:D
Last Name:FREELAND
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 1:527 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849-1415
Mailing Address - Country:US
Mailing Address - Phone:580-925-3286
Mailing Address - Fax:580-925-9149
Practice Address - Street 1:301 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4607
Practice Address - Country:US
Practice Address - Phone:580-436-5111
Practice Address - Fax:580-279-1994
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1174207Q00000X, 207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1174OtherOKLAHOMA BOARD OF MEDICAL LICENSURE
OK100147240AMedicaid
P55221Medicare UPIN
OK100147240AMedicaid
OK100522100Medicare PIN