Provider Demographics
NPI:1811995947
Name:STOCKTON, VALERIE ANN (PA)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 S KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3624
Mailing Address - Country:US
Mailing Address - Phone:405-216-3993
Mailing Address - Fax:405-513-7343
Practice Address - Street 1:1714 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3624
Practice Address - Country:US
Practice Address - Phone:405-216-3993
Practice Address - Fax:405-513-7343
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200016920BMedicaid
S68987Medicare UPIN