Provider Demographics
NPI:1972364172
Name:YEAHQUO, JARED SAMUEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:SAMUEL
Last Name:YEAHQUO
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2700 N 7TH ST APT 613
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2582
Mailing Address - Country:US
Mailing Address - Phone:918-397-0867
Mailing Address - Fax:
Practice Address - Street 1:1921 STONECIPHER DR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3439
Practice Address - Country:US
Practice Address - Phone:580-436-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical