Individual
MRS. PATRICIA JOYCE IVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1130 E. LANSING, BROKEN ARROW, OK 74012
(918) 258-9990
(918) 251-9339
Mailing address
PO BOX 140728, BROKEN ARROW, OK 74014
(918) 258-9990
(918) 994-4277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2072
OK
363AM0700X
Medical Physician Assistant
2072
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200411540A
SOONERCARE PCP ID
OK
05
—
200411540A
—
OK
Enumeration date
01/16/2012
Last updated
09/26/2018
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