Individual
JALYSSA ERICKA VALENCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2109 S HIGHWAY 69, WAGONER, OK 74467-9310
(918) 485-6069
Mailing address
2109 S HIGHWAY 69, WAGONER, OK 74467-9310
(918) 485-6069
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/23/2021
Last updated
02/23/2023
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