Lisa Dawn Eckhardt, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2550 Issued in OK

Practice address

5460 Main St Ste 102
Del City, OK 73115-5525

Phone

(405) 610-6998

NPI assigned

Nov 5, 2011

Last updated

Aug 29, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Premise Health of Oklahoma Medical, P.C

  dba Premise Health - Del City

  • Primary Care Clinic/Center
  • Del City, OK
  • NPI 1538767363
  NPD

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

{
    "created_epoch": "1320451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1366729279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 810",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640930280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 MAIN ST STE 102",
            "city": "DEL CITY",
            "state": "OK",
            "postal_code": "731155525",
            "telephone_number": "405-610-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKHARDT",
        "first_name": "LISA",
        "middle_name": "DAWN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-05",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10001357A",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2015007864",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085004016",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simone' M Driggins
• Daren Dugger
• Jennifer Durham, LMSW-PROVISIONAL
• Dynasty Care Services, LLC
• Easy Dental del City PLLC (Prime Dental Studio)
• Eva Sofia El-Assi
• Carolina Isabel Elassi
• Janis Ellen Ellifritt
• Rebecca Ellis, DNP, APRN, FNP-C
• Cara G Engelmann, P.A.

• Medical Physician Assistant in Del City, OK
• Providers in Del City, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.