Healthcare Provider Details

I. General information

NPI: 1881765808
Provider Name (Legal Business Name): AMBER DAWN PURVINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 COVELL VILLAGE DR
EDMOND OK
73003-9731
US

IV. Provider business mailing address

2556 COVELL VILLAGE DR
EDMOND OK
73003-9731
US

V. Phone/Fax

Practice location:
  • Phone: 405-938-0700
  • Fax:
Mailing address:
  • Phone: 405-938-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1333
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: