MEDICARE: DANIELLE WHEAT 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
1	363A00000X	Physician Assistant	2728	OK

General Provider Information

NPI Number	:	1427594274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE WHEAT PA-C

Provider Business Mailing Address
First Line	:	908 N ROCKFORD RD
Second Line	:	STE G
City	:	ARDMORE
State	:	OK
Zip	:	73401-2541
Country	:	US
Telephone Number	:	580-490-9411
Fax Number	:	580-490-9415

Provider Business Practice Location Address
First Line	:	908 N ROCKFORD RD STE G
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2541
Country	:	US
Telephone Number	:	580-490-9411
Fax Number	:

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

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	05/09/2017

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Directions to “ DANIELLE WHEAT PA-C” Practice Location

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