Provider Demographics
NPI:1336789718
Name:GLAZIER, KELSEY JOY (PA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JOY
Last Name:GLAZIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6050 S YALE AVE # 101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7412
Mailing Address - Country:US
Mailing Address - Phone:918-615-9605
Mailing Address - Fax:
Practice Address - Street 1:949 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5728
Practice Address - Country:US
Practice Address - Phone:918-224-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant