Provider Demographics
NPI:1881669232
Name:LECK, SONYA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:LECK
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 1:4727 GAILLARDIA PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-1927
Mailing Address - Country:US
Mailing Address - Phone:405-418-5526
Mailing Address - Fax:
Practice Address - Street 1:4727 GAILLARDIA PKWY STE 140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-1927
Practice Address - Country:US
Practice Address - Phone:405-623-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00290623OtherRAILROAD MEDICARE
OK200067750AMedicaid
OKP00290623Medicare PIN
OK244534309Medicare ID - Type Unspecified