MEDICARE: ABIGAIL J DAVISON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5579	OK
2	363A00000X	Physician Assistant	PA15361	TX

General Provider Information

NPI Number	:	1023659281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL J DAVISON PA-C

Provider Business Mailing Address
First Line	:	1245 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4214
Country	:	US
Telephone Number	:	918-579-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4214
Country	:	US
Telephone Number	:	918-579-3850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	12/01/2025

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