Provider Demographics
NPI:1184733347
Name:PARMELEE, JOHN KENNETH JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KENNETH
Last Name:PARMELEE
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:KENNETH
Other - Last Name:PARMELEE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-751-5555
Mailing Address - Fax:405-751-0726
Practice Address - Street 1:11101 HEFNER POINTE DR STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5054
Practice Address - Country:US
Practice Address - Phone:405-751-5555
Practice Address - Fax:405-751-0726
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA 692363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200197910AMedicaid
OKOK400730Medicare PIN