Provider Demographics
NPI:1184171118
Name:O'KUMA, ALLYSON E (PA-C)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:E
Last Name:O'KUMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:E
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:2 TRILLIUM WAY
Practice Address - Street 2:STE. 306
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8490
Practice Address - Country:US
Practice Address - Phone:606-526-4070
Practice Address - Fax:606-526-4072
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant