Provider Demographics
NPI:1700885845
Name:PEEPER, CHRISTIE J (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:J
Last Name:PEEPER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:J
Other - Last Name:PEEPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-977-1941
Mailing Address - Fax:580-234-8465
Practice Address - Street 1:915 E GARRIOTT RD
Practice Address - Street 2:SUITE D
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-977-1941
Practice Address - Fax:580-234-8465
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200046850AMedicaid
OK200046850AMedicaid
OKOK403427Medicare PIN
OKP00765896Medicare PIN