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Individual

MRS. JAMIE TENILLE EDMINSTEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3650 W ROCK CREEK RD, NORMAN, OK 73072-2202
(405) 364-2666
(405) 364-9627
Mailing address
4200 W MEMORIAL RD, SUITE 606, OKLAHOMA CITY, OK 73120-9350
(405) 755-1930

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
APA1602
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200105600A
OK
Enumeration date
02/05/2007
Last updated
04/02/2015
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