Provider Demographics
NPI:1134518764
Name:CHAMBERS, JILLIAN (PA-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3545 NW 58TH ST
Mailing Address - Street 2:STE 450
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4726
Mailing Address - Country:US
Mailing Address - Phone:405-951-4360
Mailing Address - Fax:866-857-2543
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-945-3197
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant