Provider Demographics
NPI:1275636706
Name:PERCIVAL, CARMEN A (PA-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:A
Last Name:PERCIVAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MOW-WAY ROAD
Mailing Address - Street 2:RACH (ATTN: MCUA-QC, MS. PRESCOTT)
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-6300
Mailing Address - Country:US
Mailing Address - Phone:580-458-2134
Mailing Address - Fax:580-458-2314
Practice Address - Street 1:4301 MOW-WAY ROAD
Practice Address - Street 2:RACH (ATTN: MCUA-QC, MS. PRESCOTT)
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant