Provider Demographics
NPI:1033480538
Name:IVEN, PATRICIA JOYCE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JOYCE
Last Name:IVEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:JOYCE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 140728
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014
Mailing Address - Country:US
Mailing Address - Phone:918-258-9990
Mailing Address - Fax:918-994-4277
Practice Address - Street 1:1130 E. LANSING
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-258-9990
Practice Address - Fax:918-251-9339
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2072363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200411540AOtherSOONERCARE PCP ID
OK200411540AMedicaid