Provider Demographics
NPI:1194429829
Name:PRANABDEV, JOYCY
Entity type:Individual
Prefix:
First Name:JOYCY
Middle Name:
Last Name:PRANABDEV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 E HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-9611
Mailing Address - Country:US
Mailing Address - Phone:580-210-9366
Mailing Address - Fax:
Practice Address - Street 1:100 S MONROE ST STE 15
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5762
Practice Address - Country:US
Practice Address - Phone:580-210-9396
Practice Address - Fax:580-245-6457
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0076371163W00000X
OK214477363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1194429829Medicaid
OK1033968771Medicaid