Provider Demographics
NPI:1740518182
Name:KRAKER, ALLYSON PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:PAIGE
Last Name:KRAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:PAIGE
Other - Last Name:DARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1801 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3446
Mailing Address - Country:US
Mailing Address - Phone:405-528-1936
Mailing Address - Fax:405-521-8260
Practice Address - Street 1:1801 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3446
Practice Address - Country:US
Practice Address - Phone:405-528-1936
Practice Address - Fax:405-521-8260
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1267363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical