Provider Demographics
NPI:1801369574
Name:CONNEYWERDY, JULIA HOPE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:HOPE
Last Name:CONNEYWERDY
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 1:302 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651-0488
Mailing Address - Country:US
Mailing Address - Phone:580-382-1966
Mailing Address - Fax:
Practice Address - Street 1:518 E LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2825
Practice Address - Country:US
Practice Address - Phone:405-533-8990
Practice Address - Fax:405-533-3103
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant