Provider Demographics
NPI:1679711410
Name:BEARCE, DEBORAH S (P A)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:BEARCE
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-6124
Mailing Address - Country:US
Mailing Address - Phone:580-229-0701
Mailing Address - Fax:580-229-1454
Practice Address - Street 1:3462 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-6124
Practice Address - Country:US
Practice Address - Phone:580-229-0701
Practice Address - Fax:580-229-1454
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00777383OtherMCR RAILROAD
OK200227530 AMedicaid
OK200227530 AMedicaid