Healthcare Provider Details

I. General information

NPI: 1346409695
Provider Name (Legal Business Name): RHONDA LEANN SEDLACEK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE STE 1304
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1200
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-5300
  • Fax: 918-494-5455
Mailing address:
  • Phone: 918-488-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-00830
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2523
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: