Active NPI
Misty Ann Wilson
- Community Health Worker
- Tahlequah, OK
National Provider Identifier
1003725060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 202518
- Practice address
- 1298 W 4TH St
Tahlequah, OK 74464-5034 - Phone
- (918) 456-8826
- NPI assigned
- Sep 4, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 202518 | OK | Primary |
Addresses
Primary practice location
1298 W 4TH St
Tahlequah, OK 74464-5034
Mailing address
1298 W 4TH St
Tahlequah, OK 74464-5034
Phone (850) 960-0554
Other practice location 1
901 NW 6th St
Stigler, OK 74462-1617
Phone (918) 967-3304
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788480000000",
"number": "1003725060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1298 W 4TH ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744645034",
"telephone_number": "850-960-0554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1298 W 4TH ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744645034",
"telephone_number": "918-456-8826"
}
],
"practiceLocations": [
{
"address_1": "901 NW 6th St",
"address_purpose": "LOCATION",
"city": "Stigler",
"state": "OK",
"postal_code": "744621617",
"country_code": "US",
"telephone_number": "918-967-3304",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "MISTY",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-09-04",
"last_updated": "2026-09-04",
"certification_date": "2026-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OK",
"license": "202518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.