Provider Demographics
NPI:1295893352
Name:PRESLEY, ROBIN L (PA-C)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:L
Other - Last Name:ERRICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1122 NE 13TH ST
Mailing Address - Street 2:ORI 236
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1039
Mailing Address - Country:US
Mailing Address - Phone:405-271-1515
Mailing Address - Fax:405-271-1001
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-7559
Practice Address - Fax:405-271-8127
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP94220Medicare UPIN
OK249702302Medicare PIN