Provider Demographics
NPI:1467458638
Name:DAVIS, AMBER L (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:MORELOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-1360
Mailing Address - Country:US
Mailing Address - Phone:405-964-2081
Mailing Address - Fax:405-964-2053
Practice Address - Street 1:105365 S. HWY 102
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-1360
Practice Address - Country:US
Practice Address - Phone:405-964-2081
Practice Address - Fax:405-964-2053
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1243363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1601243Medicaid
OKP83765Medicare UPIN
OK8EA570Medicare PIN