Provider Demographics
NPI:1205803863
Name:MONCHO, AMELIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:MONCHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 S BOULEVARD STE 175
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5868
Mailing Address - Country:US
Mailing Address - Phone:405-645-9789
Mailing Address - Fax:405-259-1023
Practice Address - Street 1:3540 S BOULEVARD STE 175
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5868
Practice Address - Country:US
Practice Address - Phone:405-645-9789
Practice Address - Fax:405-259-1023
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1144363A00000X
OK1144363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200046120AMedicaid
OK200046120AMedicaid