MEDICARE: YOLANDA MARIA PRASSADA PHYSICIAN ASSISTANT

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	1762	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811008337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA MARIA PRASSADA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE STE 280
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5555
Country	:	US
Telephone Number	:	405-657-3825
Fax Number	:	405-657-3824

Provider Business Practice Location Address
First Line	:	4833 INTEGRIS PKWY STE 200
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-8864
Country	:	US
Telephone Number	:	405-657-3825
Fax Number	:	405-657-3824

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/06/2019

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Directions to “ YOLANDA MARIA PRASSADA PHYSICIAN ASSISTANT” Practice Location

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