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NPI Code Detail

MEDICARE: JOANNA LEE HART PA-C

MEDICARE: JOANNA LEE HART 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
1363A00000XPhysician AssistantPA1236OK
2363AS0400XSurgical Physician Assistant1236OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00022710OTHERRMC

General Provider Information

NPI Number : 1669470902
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNA LEE HART PA-C
Provider Business Mailing Address
First Line : 9600 BROADWAY EXT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-7408
Country : US
Telephone Number : 405-486-2445
Fax Number :
Provider Business Practice Location Address
First Line : 9600 BROADWAY EXT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-7408
Country : US
Telephone Number : 405-486-2445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 01/16/2017

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Directions to “ JOANNA LEE HART PA-C” Practice Location

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