Provider Demographics
NPI:1073134144
Name:RICHARDSON, PARKER THOMAS (CAA)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:THOMAS
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 248846
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8846
Mailing Address - Country:US
Mailing Address - Phone:800-475-6236
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-9641
Practice Address - Fax:405-235-0738
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2024-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK31367H00000X
367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant