Provider Demographics
NPI:1942052972
Name:OLIVER, ALLISON A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:A
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:A
Other - Last Name:PENNYBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:321 E SPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2314
Mailing Address - Country:US
Mailing Address - Phone:918-852-3368
Mailing Address - Fax:
Practice Address - Street 1:9311 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5702
Practice Address - Country:US
Practice Address - Phone:918-307-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical