Provider Demographics
NPI:1013288687
Name:BUYCKS, RHEA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:MICHELLE
Last Name:BUYCKS
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 1:317 N ROCKFORD RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2552
Mailing Address - Country:US
Mailing Address - Phone:580-319-4242
Mailing Address - Fax:580-798-4612
Practice Address - Street 1:317 N ROCKFORD RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2552
Practice Address - Country:US
Practice Address - Phone:580-319-4242
Practice Address - Fax:580-798-4612
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical