Healthcare Provider Details

I. General information

NPI: 1942061700
Provider Name (Legal Business Name): RYAN ELIZABETH ALLEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13600 E 86TH ST N STE 100
OWASSO OK
74055-8732
US

IV. Provider business mailing address

1923 S UTICA AVE CREDENTIALING DEPT, GROUND FL
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-9313
  • Fax:
Mailing address:
  • Phone: 918-272-9313
  • Fax: 918-403-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: