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

Last updated

Jun 23, 2026By the provider in NPPES

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 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

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
• 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361
  Medicare reassignment
• Fort Healthcare Inc

  • Rural Health Clinic/Center
  • Fort Atkinson, WI
  • NPI 1417450115
  NPD
• 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": [],
    "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.
• Sarah Nicole Diaz, RN
• Michelle Dickau, RD
• Olivia Diedrick

• 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.