Provider Demographics
NPI:1811962251
Name:BROWN, VICKIE M (PA)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4479
Mailing Address - Country:US
Mailing Address - Phone:405-945-4710
Mailing Address - Fax:405-265-6308
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-945-4710
Practice Address - Fax:405-265-6308
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200072170AMedicaid
OKP00323228OtherRAILROAD MEDICARE
OK247601801Medicare ID - Type Unspecified
OK200072170AMedicaid