Provider Demographics
NPI:1053409052
Name:WARD, DAVID A (ARNP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:WARD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-242-1300
Mailing Address - Fax:
Practice Address - Street 1:302 N INDEPENDENCE STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4025
Practice Address - Country:US
Practice Address - Phone:580-242-1300
Practice Address - Fax:580-237-7913
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200196620AMedicaid
OK200196620AMedicaid