Provider Demographics
NPI:1093220402
Name:PANKEY, EBONIE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:EBONIE
Middle Name:
Last Name:PANKEY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 RICHMOND SQ STE 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2042
Mailing Address - Country:US
Mailing Address - Phone:405-840-1999
Mailing Address - Fax:
Practice Address - Street 1:4900 RICHMOND SQ STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2042
Practice Address - Country:US
Practice Address - Phone:405-840-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135996363LF0000X
GA251622363LF0000X
OK83510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily