Individual
BETHANY ROSE SALLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
808 WALL ST, NORMAN, OK 73069-6302
(405) 977-4321
(405) 977-0521
Mailing address
16495 TIMBERS DR, OKLAHOMA CITY, OK 73165-6530
(405) 203-8802
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3104
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200884310A
—
OK
01
—
909248
MEDICARE PTAN
OK
Enumeration date
12/09/2019
Last updated
01/10/2024
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