Active NPI
Mildred B Latham, PA-C
- Physician Assistant
- Tulsa, OK
National Provider Identifier
1417159179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1751
- Practice address
- 3606 N Cincinnati Ave
L.L.C.
Tulsa, OK 74106-1536 - Phone
- (918) 428-5373
- Fax
- (918) 428-8235
- NPI assigned
- Jun 4, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085002908 | IL | |
| Physician Assistant | 363A00000X | 1751 | OK | Primary |
Addresses
Primary practice location
3606 N Cincinnati Ave
L.L.C.
Tulsa, OK 74106-1536
Mailing address
3606 N Cincinnati Ave
L.L.C.
Tulsa, OK 74106-1536
Phone (918) 428-5373
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218499200000",
"number": "1417159179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3606 N CINCINNATI AVE",
"address_2": "L.L.C.",
"city": "TULSA",
"state": "OK",
"postal_code": "741061536",
"telephone_number": "918-428-5373",
"fax_number": "918-428-8235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3606 N CINCINNATI AVE",
"address_2": "L.L.C.",
"city": "TULSA",
"state": "OK",
"postal_code": "741061536",
"telephone_number": "918-428-5373",
"fax_number": "918-428-8235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATHAM",
"first_name": "MILDRED",
"middle_name": "B",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2008-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085002908",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "1751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.