Provider Demographics
NPI:1841274271
Name:CUMMINGS, DEANNA J (PA-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:J
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1329 S SANGRE RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1854
Mailing Address - Country:US
Mailing Address - Phone:405-533-3376
Mailing Address - Fax:405-533-1312
Practice Address - Street 1:212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:OK
Practice Address - Zip Code:74637-3023
Practice Address - Country:US
Practice Address - Phone:918-642-3100
Practice Address - Fax:918-642-5415
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100097190AMedicaid
S57661Medicare UPIN
OK242720103Medicare PIN
OK100097190AMedicaid