Healthcare Provider Details

I. General information

NPI: 1093382467
Provider Name (Legal Business Name): PARAGON GERIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15112 TRADITIONS BLVD STE A
EDMOND OK
73013-1182
US

IV. Provider business mailing address

15112 TRADITIONS BLVD STE A
EDMOND OK
73013-1182
US

V. Phone/Fax

Practice location:
  • Phone: 405-289-0483
  • Fax: 405-266-6609
Mailing address:
  • Phone: 405-289-0483
  • Fax: 405-266-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA A VERNIER
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-289-0483