Individual
MR. JAMIE SHANE MASSENGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7555 WINTERWOOD DR, EDMOND, OK 73025-1861
(405) 990-5967
Mailing address
7555 WINTERWOOD DR, EDMOND, OK 73025-1861
(405) 990-5967
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1320
OK
Other
Enumeration date
09/05/2006
Last updated
02/09/2020
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