MEDICARE: ERICA CAMILLETTI 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	2403	OK

General Provider Information

NPI Number	:	1528481322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA CAMILLETTI PA-C

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE
Second Line	:	SUITE 280
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5556
Country	:	US
Telephone Number	:	580-482-9020
Fax Number	:	580-480-3113

Provider Business Practice Location Address
First Line	:	201 S PARK LN
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-5733
Country	:	US
Telephone Number	:	580-482-9020
Fax Number	:	580-480-3113

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

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	02/03/2016

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Directions to “ ERICA CAMILLETTI PA-C” Practice Location

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