Provider Demographics
NPI:1124094859
Name:ZIELENSKI, BLYTHE H (PA)
Entity type:Individual
Prefix:
First Name:BLYTHE
Middle Name:H
Last Name:ZIELENSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2343
Mailing Address - Country:US
Mailing Address - Phone:918-331-2500
Mailing Address - Fax:918-331-2506
Practice Address - Street 1:3400 FRANK PHILLIPS
Practice Address - Street 2:SUITE 702
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-331-2500
Practice Address - Fax:918-331-2506
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00943363AM0700X
OK1032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103732OtherBLUE CROSS BLUE SHIELD
KS200258890AMedicaid
KS200258890AMedicaid