Healthcare Provider Details

I. General information

NPI: 1871311142
Provider Name (Legal Business Name): ABIGAIL NICOLE TREJO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 7F
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

3004 SE 22ND CIR
OKLAHOMA CITY OK
73115-1548
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2244
  • Fax: 405-271-2144
Mailing address:
  • Phone: 806-736-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5710
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: