Individual provider Active NPI

Marshall Krizoa Nguessan, AUD.

  • Audiologist
  • Lawton, OK
National Provider Identifier
1689670077
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
305 Issued in OK
Practice address
1102 SE 36TH St
Ste B
Lawton, OK 73501-8458
Phone
(580) 351-2278
Fax
(580) 353-0462
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 305 OK Primary
Audiologist 231H00000X 51685 TX

Addresses

Primary practice location

1102 SE 36TH St
Ste B
Lawton, OK 73501-8458

Mailing address

501 S 11TH St
Marlow, OK 73055-3025
Phone (580) 658-2468

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

State licenses

LicenseStateTypeSpecialty
51685TXMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wallace B. McLeod III, Inc PastSince Jul 18, 2010 Accepting new patients
Crow Family Medicine Clinic, PC Past Accepting new patients
Wallace B McLeod III, Inc Past Accepting new patients
Advanced Health Systems of America, PC Past Accepting new patients
Lawton General Surgery Clinic Past Accepting new patients
Henry-Norbert Ndekwe MD PC PastSince Nov 6, 2008 Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1689670077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 11TH ST",
            "city": "MARLOW",
            "state": "OK",
            "postal_code": "730553025",
            "telephone_number": "580-658-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 SE 36TH ST",
            "address_2": "STE B",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735018458",
            "telephone_number": "580-351-2278",
            "fax_number": "580-353-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUESSAN",
        "first_name": "MARSHALL",
        "middle_name": "KRIZOA",
        "name_prefix": "Dr.",
        "credential": "AUD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OK",
            "license": "305",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "TX",
            "license": "51685",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.