Individual provider Active NPI

Bryanna Paulson, PA-C

  • Physician Assistant
  • Stillwater, OK
National Provider Identifier
1629950845
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5686 Issued in OK
Practice address
1323 W 6TH Ave
Stillwater, OK 74074-4399
Phone
(405) 784-5842
NPI assigned
Jul 21, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5686 OK Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

1323 W 6TH Ave
Stillwater, OK 74074-4399

Mailing address

14775 Federal Blvd
Broomfield, CO 80023-9434

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251008004346 OK Practitioner - Physician Assistant 0648777276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

307 S Evergreen Ave
Woodbury, NJ 08096-2739

Hospital & facility affiliations

  • Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Emergency Services PC Physician Assistant CurrentSince Nov 1, 2025 Accepting new patients

Locations

1323 W 6th Ave
Stillwater, OK 74074
Phone (405) 372-1480

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1753056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1629950845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14775 FEDERAL BLVD",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800239434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1323 W 6TH AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744399",
            "telephone_number": "405-784-5842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "BRYANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "5686",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, OK

Sources for this page

Verify at the official NPI Registry.