Healthcare Provider Details

I. General information

NPI: 1801108311
Provider Name (Legal Business Name): VY AI TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SW 119TH STREET SUITE A
OKLAHOMA CITY OK
73170
US

IV. Provider business mailing address

P.O. BOX 722225
NORMAN OK
73070
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-9788
  • Fax: 405-735-9882
Mailing address:
  • Phone: 405-292-5500
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1677
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2656
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: