Provider Demographics
NPI:1649882556
Name:FERGUSON, PARISSA KESHAVARZIAN (PA)
Entity type:Individual
Prefix:
First Name:PARISSA
Middle Name:KESHAVARZIAN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 NW 58TH ST STE 910-W
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4707
Mailing Address - Country:US
Mailing Address - Phone:405-653-9161
Mailing Address - Fax:405-653-9163
Practice Address - Street 1:3555 NW 58TH ST STE 910-W
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4707
Practice Address - Country:US
Practice Address - Phone:405-653-9161
Practice Address - Fax:405-653-9163
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant