Provider Demographics
NPI:1922107648
Name:PRIESTER, ADELAIDE L (DO)
Entity Type:Individual
Prefix:MRS
First Name:ADELAIDE
Middle Name:L
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:244 S. GATEWAY PLACE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037
Mailing Address - Country:US
Mailing Address - Phone:918-747-2020
Mailing Address - Fax:918-747-2056
Practice Address - Street 1:4444 S HARVARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2634
Practice Address - Country:US
Practice Address - Phone:918-747-2020
Practice Address - Fax:918-747-2056
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2472207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100176260AMedicaid
OK1457746OtherUNITED HEALTHCARE
OK4573409OtherAETNA
OKP00435261Medicare PIN
OK4573409OtherAETNA
OKE09777Medicare UPIN