Provider Demographics
NPI:1205813136
Name:DORSEY, JOYCE ELLEN (PA)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELLEN
Last Name:DORSEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:ELLEN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1011 HONOR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1318
Mailing Address - Country:US
Mailing Address - Phone:918-577-3997
Mailing Address - Fax:918-577-3879
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-3997
Practice Address - Fax:918-577-3879
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1112363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P29226Medicare UPIN