Healthcare Provider Details

I. General information

NPI: 1184733347
Provider Name (Legal Business Name): JOHN KENNETH PARMELEE JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN KENNETH PARMELEE JR. PA-C

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 HEFNER POINTE DR STE 105
OKLAHOMA CITY OK
73120-5054
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-5555
  • Fax: 405-751-0726
Mailing address:
  • Phone: 405-751-5555
  • Fax: 405-751-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 692
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: