Provider Demographics
NPI:1336370113
Name:JOYKUTTY, DIVYA (APRN)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:JOYKUTTY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4207
Mailing Address - Country:US
Mailing Address - Phone:405-691-9700
Mailing Address - Fax:405-691-9702
Practice Address - Street 1:10700 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4207
Practice Address - Country:US
Practice Address - Phone:405-691-9700
Practice Address - Fax:405-691-9702
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72409363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200254270AMedicaid