Provider Demographics
NPI:1104302637
Name:CRAIN, JAMIE ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:CRAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:ELIZABETH
Other - Last Name:CRAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4050 W MEMORIAL RD FL 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-753-1865
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant