Healthcare Provider Details

I. General information

NPI: 1942052972
Provider Name (Legal Business Name): ALLISON A OLIVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON A PENNYBAKER PA-C

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9311 S MINGO RD
TULSA OK
74133-5702
US

IV. Provider business mailing address

321 E SPEER AVE
SAPULPA OK
74066-2314
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-1613
  • Fax:
Mailing address:
  • Phone: 918-852-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: