Provider Demographics
NPI:1417051921
Name:A'BELLE, N DEVONNA (PA-C, DMSC)
Entity Type:Individual
Prefix:DR
First Name:N
Middle Name:DEVONNA
Last Name:A'BELLE
Suffix:
Gender:F
Credentials:PA-C, DMSC
Other - Prefix:MRS
Other - First Name:NILA
Other - Middle Name:DEVONNA
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:18555 S PARK PL
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-3033
Mailing Address - Country:US
Mailing Address - Phone:918-693-6601
Mailing Address - Fax:
Practice Address - Street 1:4705 S 129TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7005
Practice Address - Country:US
Practice Address - Phone:918-727-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AM0700X
OKPA 464363AM0700X
OK464363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK464OtherOKLAHOMA LICENSE
OK20084730AMedicaid
OKOK100210Medicare PIN