Individual
AMANDA JEAN ELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1705 E 19TH ST, SUITE 302, TULSA, OK 74104-5405
(918) 748-7585
(918) 403-6352
Mailing address
PO BOX 25277, OVERLAND PARK, KS 66225-5277
(918) 307-6920
(918) 307-6951
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1429
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200067560A
—
OK
01
—
P00878501
MEDICARE RAILROAD
OK
Enumeration date
02/10/2006
Last updated
07/22/2016
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