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General NPI Number Information
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NPI Number | 1336789718
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Entity Type | Individual
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Provider Name | KELSEY JOY GLAZIER PA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 949 E TAFT AVE
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City | SAPULPA
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State | OK
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Zip | 74066-5728
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Country | US
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Telephone | 918-224-6079
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Fax |
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Provider Business Mailing Address
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Address Line | 6050 S YALE AVE # 101
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City | TULSA
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State | OK
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Zip | 74135-7412
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Country | US
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Telephone | 918-615-9605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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