NPIMap

Individual provider Active NPI

Mary Kay Daugherty, PA-C

  • Surgical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1487323036
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4776 Issued in OK
Practice address
1809 E 13TH St Ste 200
Tulsa, OK 74104-4431
Phone
(918) 579-2300
NPI assigned
Sep 8, 2021
Last updated
Aug 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 4776 OK Primary

Addresses

Primary practice location

1809 E 13TH St Ste 200
Tulsa, OK 74104-4431

Mailing address

1809 E 13TH St Ste 200
Tulsa, OK 74104-4431
Phone (918) 579-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220523001129 OK Practitioner - Physician Assistant 3274910732 Reassigns benefits to 3 organizations
I20240801004312 TX Practitioner - Physician Assistant 3274910732 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ahs Oklahoma Physician Group LLCGroup PAC ID 9436122496, 314 clinicians

Practice addresses (Care Compare)

1120 S Utica Ave
Tulsa, OK 74104-4012
Phone (918) 579-9393

1308 E Carl Albert Pkwy
Suite a
McAlester, OK 74501-5236
Phone (918) 558-6970

1809 E 13TH St
Tulsa, OK 74104-4431

20 E 34TH St
Sand Springs, OK 74063-4001
Phone (918) 245-9675

6901 S Olympia Ave
Tulsa, OK 74132-1843
Phone (918) 388-5701

8801 S 101St E Ave
Tulsa, OK 74133-5716
Phone (918) 294-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.4 of 100Reported as group
Quality
72.78
Promoting interoperability
98
Improvement activities
40
Cost
76.77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4776OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cherokee Nation CurrentSince Jul 22, 2024 Accepting new patients
Stillwater Medical Center Authority CurrentSince May 27, 2025 Accepting new patients
Cherokee Nation CurrentSince Jul 22, 2024 Accepting new patients
Stillwater Medical Center Authority Current Accepting new patients
Cherokee Nation Current Accepting new patients
Cherokee Nation Current Accepting new patients
Stillwater Medical Center Physicians Past Accepting new patients

Locations

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

417 Fairview Ave
Ponca City, OK 74601
Phone (580) 762-3770

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Interoperability endpoints

  • Direct secure messaging: marykay.daugherty.p1@direct.smc.nextgenshare.com
  • Direct secure messaging: mdaugherty574808@ahs.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1487323036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 E 13TH ST STE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044431",
            "telephone_number": "918-579-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 E 13TH ST STE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044431",
            "telephone_number": "918-579-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "MARY",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-08",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "4776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.