MEDICARE: ALICIA YORK

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
1	363A00000X	Physician Assistant		OK

General Provider Information

NPI Number	:	1386114627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA YORK

Provider Business Mailing Address
First Line	:	14000 N PORTLAND AVE STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-4004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14000 N PORTLAND AVE STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-4004
Country	:	US
Telephone Number	:	405-751-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	10/27/2019

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Directions to “ ALICIA YORK ” Practice Location

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