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NPI Code Detail

MEDICARE: VANESSA PROFIT PA-C

MEDICARE: VANESSA PROFIT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1104399930
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA PROFIT PA-C
Provider Business Mailing Address
First Line : 3501 E GORE BLVD APT 1015
Second Line :
City : LAWTON
State : OK
Zip : 73501-6858
Country : US
Telephone Number : 240-688-2490
Fax Number :
Provider Business Practice Location Address
First Line : 4301 WILSON ST
Second Line :
City : FORT SILL
State : OK
Zip : 73503-4472
Country : US
Telephone Number : 240-688-2490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2019
Last Update Date : 05/20/2026

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Directions to “ VANESSA PROFIT PA-C” Practice Location

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