Miranda R Dethier, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2758-23 Issued in WI

Practice address

W165N5595 Creekwood Xing
Menomonee Falls, WI 53051-0685

Phone

(262) 252-1050

Fax

(262) 525-4781

NPI assigned

Jul 21, 2011

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

Other identifiers 1

Other names 1

• Miss Miranda Rae Gordy Former name

Medicare fee-for-service enrollment

Enrolled in WI

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

Interoperability endpoints

• Direct secure messaging: miranda.dethier@direct.forthc.com

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.

• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361
  Medicare reassignment
• Watertown Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Watertown, WI
  • NPI 1225412265

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1760770960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 E RED PINE CIR",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "531188828",
            "telephone_number": "608-921-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W165N5595 CREEKWOOD XING",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530510685",
            "telephone_number": "262-252-1050",
            "fax_number": "262-525-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHIER",
        "first_name": "MIRANDA",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-21",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2758-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760770960",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "GORDY",
            "middle_name": "RAE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Lewis Delcore, P.T.
• Mario F Deluca, HIS
• Kristina Denter, PHARM D
• Kelley Marie Dentino, D.M.D.
• Luke V Desjarlais, PAC
• Mindy May Deura, BSN, RN, CDCES
• Stacey M. Deutsch, R.D.
• Michelle Dickau, RD
• Olivia Diedrick
• Mary P. Dimick, OT

• Physician Assistant in Menomonee Falls, WI
• Providers in Menomonee Falls, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; 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.