Provider Demographics
NPI:1568827426
Name:MCKOY, ASHLEY NICHOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:MCKOY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICHOLE
Other - Last Name:CORNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1265 S UTICA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4243
Mailing Address - Country:US
Mailing Address - Phone:918-592-0999
Mailing Address - Fax:
Practice Address - Street 1:1265 S UTICA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4243
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-20
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant