Provider Demographics
NPI:1831511328
Name:MCCAULEY-YOUNG, ANGELA (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCAULEY-YOUNG
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-7463
Mailing Address - Fax:405-307-5704
Practice Address - Street 1:724 24TH AVE NW
Practice Address - Street 2:SUITE 220
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6218
Practice Address - Country:US
Practice Address - Phone:405-307-5700
Practice Address - Fax:405-307-5704
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant