NPI 1356739486 · live from the CMS NPI Registry
Koby Anderson, PA-C
Physician Assistant in Oklahoma City, OK. National Provider Identifier 1356739486, active.
NPI record
| NPI | 1356739486 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 3110 Sw 89th St Ste 200e, Oklahoma City, OK 73159 |
| Practice phone | 405-486-6720 |
| Enumerated | December 23, 2014 |
| Last updated | February 13, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 076350 (IA) |
| Physician Assistant primary | 363A00000X | 2475 (OK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.