MEDICARE: CAROL DIANE WINK 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
1	363A00000X	Physician Assistant	1147	NE
2	363A00000X	Physician Assistant	1455	OK

General Provider Information

NPI Number	:	1265516827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL DIANE WINK PA-C

Provider Business Mailing Address
First Line	:	402 W MORROW RD
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-6549
Country	:	US
Telephone Number	:	918-295-1328
Fax Number	:	918-403-6313

Provider Business Practice Location Address
First Line	:	402 W MORROW RD
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-6549
Country	:	US
Telephone Number	:	918-295-1328
Fax Number	:	918-403-6313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/09/2019

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Directions to “ CAROL DIANE WINK PA-C” Practice Location

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