Provider Demographics
NPI:1659558708
Name:MANGUM, ROBYN DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:DAWN
Last Name:MANGUM
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 1:1318 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5034
Mailing Address - Country:US
Mailing Address - Phone:580-336-9411
Mailing Address - Fax:580-336-9422
Practice Address - Street 1:1318 ELM ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5034
Practice Address - Country:US
Practice Address - Phone:580-336-9411
Practice Address - Fax:580-336-9422
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant