Provider Demographics
NPI:1881765808
Name:PURVINE, AMBER DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:PURVINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 COVELL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-9731
Mailing Address - Country:US
Mailing Address - Phone:405-938-0700
Mailing Address - Fax:
Practice Address - Street 1:2556 COVELL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-9731
Practice Address - Country:US
Practice Address - Phone:405-938-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant