Provider Demographics
NPI:1538237094
Name:SALLEE, CASSANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SALLEE
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MILBURN
Mailing Address - State:OK
Mailing Address - Zip Code:73450-0067
Mailing Address - Country:US
Mailing Address - Phone:580-443-3533
Mailing Address - Fax:580-443-3536
Practice Address - Street 1:104 WEST F STREET
Practice Address - Street 2:
Practice Address - City:MILBURN
Practice Address - State:OK
Practice Address - Zip Code:73450-0067
Practice Address - Country:US
Practice Address - Phone:580-443-3533
Practice Address - Fax:580-443-3536
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP96465Medicare UPIN