Provider Demographics
NPI:1932253275
Name:MERCER, AMY ELIZABETH (PA C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:MERCER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:202 A ST SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-7604
Mailing Address - Country:US
Mailing Address - Phone:918-541-9400
Mailing Address - Fax:918-541-9411
Practice Address - Street 1:202 A ST SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7604
Practice Address - Country:US
Practice Address - Phone:918-541-9400
Practice Address - Fax:918-541-9411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA1624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468380YMedicaid
OK200107870AMedicaid
OK900522214Medicare PIN
OK200107870AMedicaid
OKQ77542Medicare UPIN