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General NPI Number Information
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NPI Number | 1902513682
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Entity Type | Individual
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Provider Name | RAOUL J K ACHA PA
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Gender | Male
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 1102 W MACARTHUR ST
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City | SHAWNEE
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State | OK
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Zip | 74804-1743
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Country | US
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Telephone | 405-273-2270
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Fax |
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Provider Business Mailing Address
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Address Line | 12717 QUAKER DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-5135
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Country | US
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Telephone | 181-790-3473
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4883
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4883
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License Number State | OK
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