Healthcare Provider Details

I. General information

NPI: 1679117717
Provider Name (Legal Business Name): ALLISON RAE DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON RAE EDWARDS PA-C

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 08/14/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD STE 210
EDMOND OK
73013-3023
US

IV. Provider business mailing address

PO BOX 2378
EDMOND OK
73083-2378
US

V. Phone/Fax

Practice location:
  • Phone: 405-768-1600
  • Fax: 405-768-1601
Mailing address:
  • Phone: 405-768-1600
  • Fax: 405-768-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3107
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: