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NPI Code Detail

MEDICARE: MR. KENNETH A ADAMS PA-C

MEDICARE:  MR. KENNETH A ADAMS  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA376OK

General Provider Information

NPI Number : 1366531337
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH A ADAMS PA-C
Provider Business Mailing Address
First Line : 2619 GEORGIA AVE
Second Line :
City : MUSKOGEE
State : OK
Zip : 74403-7670
Country : US
Telephone Number : 918-682-4085
Fax Number :
Provider Business Practice Location Address
First Line : 3001 W BLUE STARR DR
Second Line :
City : CLAREMORE
State : OK
Zip : 74017-2544
Country : US
Telephone Number : 918-342-5432
Fax Number : 918-342-0835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 07/08/2007

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Directions to “ MR. KENNETH A ADAMS PA-C” Practice Location

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