Kelly Dawn Moak, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2482 Issued in OK

Practice address

14321 NE 23Rd St
Choctaw, OK 73020-8624

Phone

(405) 342-0255

Fax

(405) 610-6960

NPI assigned

Sep 14, 2006

Sex

Female

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Eldercounseling and Clinical Services PLLC

  • Clinical Social Worker
  • Norman, OK
  • NPI 1922244078
  NPD (past)
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• Millennium Medical Services, L.L.C.

  • Psychiatry Physician
  • Norman, OK
  • NPI 1245286285
  NPD (past)

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1598860520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14321 NE 23RD ST",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730208624",
            "telephone_number": "405-342-0255",
            "fax_number": "405-610-6960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 W Iowa Ave",
            "address_purpose": "LOCATION",
            "city": "Chickasha",
            "state": "OK",
            "postal_code": "730182736",
            "country_code": "US",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOAK",
        "first_name": "KELLY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanne Miller, M.S. CCC-SLP
• Darian Yea Miller, MFT-C
• Jennifer Lynn Miller, BCBA
• Mendi J Mills, BASOCIOLOGY
• Esther Mary Mitchell
• Larry G Mobly, DO
• Caree Moon, PTA
• Jamie Sue Moseley
• Taylor Newman
• Mindy Truc Ngo, RPH

• Medical Physician Assistant in Choctaw, OK
• Providers in Choctaw, 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 Mar 17, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.