Active NPI
Suzzie J Waldenville, P.A.-C
- Physician Assistant
- Stigler, OK
National Provider Identifier
1386701696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 627
- Practice address
- 401 NW H St
Stigler, OK 74462-1625 - Phone
- (918) 967-4682
- Fax
- (918) 967-8694
- NPI assigned
- Jan 3, 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 | 627 | OK | Primary |
Addresses
Primary practice location
401 NW H St
Stigler, OK 74462-1625
Mailing address
401 NW H St
P.O. Box 728
Stigler, OK 74462-1625
Phone (918) 967-4682
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100716300B | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 627 | OK | MD | Other Specialist/Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Best Physicians at Home, Inc | Past | Accepting new patients | |
| Physicians at Home, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/21335/brand/1/csg/1/fhir/r4
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 and National Provider Directory roles.
-
- General Practice Physician
- Chandler, OK
- NPI 1447659768
-
- Geriatric Medicine (Family Medicine) Physician
- Oklahoma City, OK
- NPI 1487824595
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241049600000",
"number": "1386701696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 NW H ST",
"address_2": "P.O. BOX 728",
"city": "STIGLER",
"state": "OK",
"postal_code": "744621625",
"telephone_number": "918-967-4682",
"fax_number": "918-967-8694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 NW H ST",
"city": "STIGLER",
"state": "OK",
"postal_code": "744621625",
"telephone_number": "918-967-4682",
"fax_number": "918-967-8694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDENVILLE",
"first_name": "SUZZIE",
"middle_name": "J",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2009-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "627",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100716300B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stigler, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.