Provider Demographics
NPI:1124036744
Name:VAVERKA, LORA MAY (NP-C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MAY
Last Name:VAVERKA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 HEFNER POINTE DR STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5049
Mailing Address - Country:US
Mailing Address - Phone:405-752-0871
Mailing Address - Fax:405-755-9510
Practice Address - Street 1:330 S 5TH ST STE 500
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-249-5504
Practice Address - Fax:580-234-5933
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0051279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100114140AMedicaid
OK100114140AMedicaid
OK317728YPW9Medicare PIN