Provider Demographics
NPI:1679117717
Name:DAVIS, ALLISON RAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:RAE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2378
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-2378
Mailing Address - Country:US
Mailing Address - Phone:405-768-1600
Mailing Address - Fax:405-768-1601
Practice Address - Street 1:941 W I 35 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7364
Practice Address - Country:US
Practice Address - Phone:405-768-1600
Practice Address - Fax:405-768-1601
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OK3107363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1169488OtherNCCPA