Provider Demographics
NPI:1811294754
Name:DRENNEN, AMBER M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:M
Last Name:DRENNEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:KUZMIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1226 NORTH SHARTEL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103
Mailing Address - Country:US
Mailing Address - Phone:405-232-8003
Mailing Address - Fax:405-232-8008
Practice Address - Street 1:1226 NORTH SHARTEL
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103
Practice Address - Country:US
Practice Address - Phone:405-232-8003
Practice Address - Fax:405-232-8008
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA 1951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant