Provider Demographics
NPI:1740907500
Name:FORD HOLDMEYER, KASSIDY TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:TAYLOR
Last Name:FORD HOLDMEYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-470-2590
Mailing Address - Fax:405-470-0619
Practice Address - Street 1:9417 N COUNCIL RD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6228
Practice Address - Country:US
Practice Address - Phone:405-470-2590
Practice Address - Fax:405-470-0619
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant