Jason Tyler Gordon Graham, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

222349 Issued in AR

Practice address

104 Wall St
Poteau, OK 74953-4405

Phone

(918) 635-3508

Fax

(918) 635-3550

NPI assigned

Aug 10, 2023

Last updated

May 8, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leflore County Hospital AuthorityGroup PAC ID 7719916956, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eastern Oklahoma Medical Center Hospital, Poteau, OK, CCN 371337
• Mercy Hospital Fort Smith Hospital, Fort Smith, AR, CCN 040062

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Leflore County Hospital Authority

  dba Family Medical Clinic

  • Rural Health Clinic/Center
  • Poteau, OK
  • NPI 1043265895
  Medicare reassignment Care Compare group NPD
• Leflore County Hospital Authority

  dba Heavener Medical Clinic

  • Rural Health Clinic/Center
  • Heavener, OK
  • NPI 1558740837
  NPD
• Leflore County Hospital Authority

  dba Cavanal Medical Clinic

  • Family Medicine Physician
  • Poteau, OK
  • NPI 1578026571
  NPD
• Leflore County Hospital Authority

  dba Eastern Oklahoma Medical Center

  • Critical Access Hospital
  • Poteau, OK
  • NPI 1396767158
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Leflore County Hospital Authority

  dba Mountain Gateway Senior Health

  • Psychiatric Hospital Unit
  • Poteau, OK
  • NPI 1184997447
  Care Compare affiliation
• Leflore County Hospital Authority

  dba Eastern Oklahoma Medical Center

  • Critical Access Hospital
  • Poteau, OK
  • NPI 1396767158
  Care Compare affiliation
• Mercy Hospital Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1568433480
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1285317735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WALL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534433",
            "telephone_number": "918-635-3566",
            "fax_number": "918-635-3568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WALL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534405",
            "telephone_number": "918-635-3508",
            "fax_number": "918-635-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "JASON",
        "middle_name": "TYLER GORDON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-10",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "222349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Raelyn Goolsby
• Taylar Gorgas, LCSW
• Lois L Gotes, NP
• Penny Gragg
• Aubrey Graham
• Jayni Ellen Graham, LPN
• Michele A Graham, B.S. PSYCHOLOGY
• Matt L Grantham, O.D.
• Amy Graves
• Christy Gray, PTA

• Family Nurse Practitioner in Poteau, OK
• Providers in Poteau, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.