Provider Demographics
NPI:1255871349
Name:STARR, MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:STARR
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 1:409 NW 39TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8606
Mailing Address - Country:US
Mailing Address - Phone:405-820-7249
Mailing Address - Fax:405-951-9872
Practice Address - Street 1:409 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-8415
Practice Address - Country:US
Practice Address - Phone:405-820-7249
Practice Address - Fax:405-951-9872
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical