Basic Information
| Provider Information | |||||||||
| NPI: | 1528146628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TELCOCCI | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14024 QUAIL POINTE DR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054198447 | ||||||||
| FaxNumber: | 4054197745 | ||||||||
| Practice Location | |||||||||
| Address1: | 9800 BROADWAY EXTENSION | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057154496 | ||||||||
| FaxNumber: | 4057154499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1001 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.