Provider Demographics
NPI:1497396386
Name:HARVEY, TALYNN OCENA (PA-S2)
Entity type:Individual
Prefix:
First Name:TALYNN
Middle Name:OCENA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PA-S2
Other - Prefix:
Other - First Name:TALYNN
Other - Middle Name:OCENA
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8713 MILWAUKEE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0927
Mailing Address - Country:US
Mailing Address - Phone:880-640-7588
Mailing Address - Fax:
Practice Address - Street 1:8713 MILWAUKEE AVE STE 100
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0927
Practice Address - Country:US
Practice Address - Phone:806-407-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA14030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program