Provider Demographics
NPI:1265597553
Name:PHUNG, NENETH OAKLEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NENETH
Middle Name:OAKLEY
Last Name:PHUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NENETH
Other - Middle Name:
Other - Last Name:OAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5713 SE 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6076
Mailing Address - Country:US
Mailing Address - Phone:405-869-7235
Mailing Address - Fax:
Practice Address - Street 1:2733 SOUTH I-35 SERVICE ROAD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160
Practice Address - Country:US
Practice Address - Phone:405-814-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ46034Medicare UPIN