MEDICARE: AMY ELIZABETH PEDLOW 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	363AM0700X	Medical Physician Assistant	PA 1252	OK

General Provider Information

NPI Number	:	1649246331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELIZABETH PEDLOW PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1330
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-1330
Country	:	US
Telephone Number	:	405-307-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 MAGNOLIA CT STE 113
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-1420
Country	:	US
Telephone Number	:	405-595-1115
Fax Number	:	405-242-0043

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	09/29/2025

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