Provider Demographics
NPI:1043280100
Name:CHERRY, RONDA L (PA-C)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:L
Last Name:CHERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:L
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 N DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-1420
Mailing Address - Country:US
Mailing Address - Phone:918-596-8879
Mailing Address - Fax:918-596-8961
Practice Address - Street 1:300 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-1420
Practice Address - Country:US
Practice Address - Phone:918-596-8900
Practice Address - Fax:918-596-8961
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKUPINMedicare UPIN