Provider Demographics
NPI:1184197899
Name:LAVENDER, HOLLY RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENEE
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6839 S CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3402
Mailing Address - Country:US
Mailing Address - Phone:918-392-4685
Mailing Address - Fax:918-392-4693
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-392-4685
Practice Address - Fax:918-392-4693
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2023-09-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant