Healthcare Provider Details

I. General information

NPI: 1255673349
Provider Name (Legal Business Name): KATHRYN MARIE FEISAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MARIE RHODES

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD SUITE 208
OKLAHOMA CITY OK
73120-8366
US

IV. Provider business mailing address

4140 W MEMORIAL RD SUITE 208
OKLAHOMA CITY OK
73120-8366
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-4230
  • Fax: 405-749-4228
Mailing address:
  • Phone: 405-749-4230
  • Fax: 405-749-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAPA2251
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: