Provider Demographics
NPI:1588183156
Name:WARD, MARY EVELYN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EVELYN
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 96288
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-6288
Mailing Address - Country:US
Mailing Address - Phone:800-962-3303
Mailing Address - Fax:405-609-1466
Practice Address - Street 1:81 BALL PARK RD
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1701
Practice Address - Country:US
Practice Address - Phone:606-573-8201
Practice Address - Fax:405-609-1466
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024183241363L00000X
KY3011843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner