Provider Demographics
NPI:1245501105
Name:SPELLS, AARON (PA-C)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:SPELLS
Suffix:
Gender:M
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 1:2410 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1356
Mailing Address - Country:US
Mailing Address - Phone:580-226-0812
Mailing Address - Fax:580-226-0820
Practice Address - Street 1:2410 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1356
Practice Address - Country:US
Practice Address - Phone:580-226-0812
Practice Address - Fax:580-226-0820
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant