Unknown Individual – Physician Assistant, NPI 1164408928
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
North Country Club Road, Ada, Pontotoc County, Oklahoma, 74820, United States
ADA, OK 748202847
Phone: (580) 421-4570
Fax: (580) 421-6283
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 74820)
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