Provider Demographics
NPI:1316955073
Name:HEAD, AARON WAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:WAYNE
Last Name:HEAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:OK
Mailing Address - Zip Code:74855-0190
Mailing Address - Country:US
Mailing Address - Phone:405-416-3739
Mailing Address - Fax:
Practice Address - Street 1:6500 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-6918
Practice Address - Country:US
Practice Address - Phone:405-954-3711
Practice Address - Fax:405-954-9112
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK865363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical