Provider Demographics
NPI:1972083921
Name:BHAKTA, POOJA (PA-C)
Entity Type:Individual
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First Name:POOJA
Middle Name:
Last Name:BHAKTA
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:STANBRO HEALTHCARE GROUP LLC
Mailing Address - Street 2:2000 E. 15TH ST., SUITE 400-A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-341-1697
Mailing Address - Fax:405-341-2672
Practice Address - Street 1:STANBRO HEALTHCARE GROUP LLC
Practice Address - Street 2:2000 E. 15TH ST., SUITE 400-A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-341-1697
Practice Address - Fax:405-341-2672
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2019-05-23
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Provider Licenses
StateLicense IDTaxonomies
OK2944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant