Provider Demographics
NPI:1528146628
Name:TELCOCCI, CHRISTINA (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TELCOCCI
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 1:14024 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1006
Mailing Address - Country:US
Mailing Address - Phone:405-419-8447
Mailing Address - Fax:405-419-7745
Practice Address - Street 1:9800 BROADWAY EXTENSION
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-715-4496
Practice Address - Fax:405-715-4499
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK402401Medicare PIN
OKP05936Medicare UPIN
OK100097340AMedicaid
OK26673683OtherMEDICARE RR
OK970017948OtherMEDICARE RR