Provider Demographics
NPI:1174596100
Name:ARMIGER, JAEMIE ANN (PA)
Entity type:Individual
Prefix:MS
First Name:JAEMIE
Middle Name:ANN
Last Name:ARMIGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAEMIE
Other - Middle Name:ANN
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 W JUNEAU ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0767
Mailing Address - Country:US
Mailing Address - Phone:918-813-1351
Mailing Address - Fax:
Practice Address - Street 1:4103 S YALE AVE STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6002
Practice Address - Country:US
Practice Address - Phone:918-495-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200005890AMedicaid
OKP84955Medicare UPIN
OK245533901Medicare ID - Type Unspecified