Provider Demographics
NPI:1902669229
Name:SALOUS, RAND (PA-C)
Entity Type:Individual
Prefix:
First Name:RAND
Middle Name:
Last Name:SALOUS
Suffix:
Gender:F
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 1:16508 VILLAGE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7078
Mailing Address - Country:US
Mailing Address - Phone:405-365-8736
Mailing Address - Fax:
Practice Address - Street 1:16508 VILLAGE GARDEN DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-7078
Practice Address - Country:US
Practice Address - Phone:405-365-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant