Active NPI
Carmen A Percival, PA-C
- Physician Assistant
- Fort Sill, OK
National Provider Identifier
1275636706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 998
- Practice address
- 4301 Mow-Way Road
Rach (Attn: McUa-QC, Ms. Prescott)
Fort Sill, OK 73503-6300 - Phone
- (580) 458-2134
- Fax
- (580) 458-2314
- NPI assigned
- Sep 7, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 998 | OK | Primary |
Addresses
Primary practice location
4301 Mow-Way Road
Rach (Attn: McUa-QC, Ms. Prescott)
Fort Sill, OK 73503-6300
Mailing address
4301 Mow-Way Road
Rach (Attn: McUa-QC, Ms. Prescott)
Fort Sill, OK 73503-6300
Phone (580) 458-2134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 998 | OK | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lawton Indian Hospital | Current | Accepting new patients |
Locations
1515 NE Lawrie Tatum Rd
Lawton, OK 73507
Phone (580) 353-0350
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba WellFast Urgent Care Center East
- Urgent Care Clinic/Center
- Lawton, OK
- NPI 1891027371
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275636706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 MOW-WAY ROAD",
"address_2": "RACH (ATTN: MCUA-QC, MS. PRESCOTT)",
"city": "FORT SILL",
"state": "OK",
"postal_code": "735036300",
"telephone_number": "580-458-2134",
"fax_number": "580-458-2314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4301 MOW-WAY ROAD",
"address_2": "RACH (ATTN: MCUA-QC, MS. PRESCOTT)",
"city": "FORT SILL",
"state": "OK",
"postal_code": "735036300",
"telephone_number": "580-458-2134",
"fax_number": "580-458-2314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERCIVAL",
"first_name": "CARMEN",
"middle_name": "A",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.