NPIMap

Individual provider Active NPI

Lacey Gardner, PA-C

  • Physician Assistant
  • Paris, TX
National Provider Identifier
1790226504
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11191 Issued in TX
Practice address
865 Deshong Dr
Paris, TX 75460-9313
Phone
(903) 785-4521
NPI assigned
Mar 13, 2017
Last updated
Jul 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11191 TX Primary

Addresses

Primary practice location

865 Deshong Dr
Paris, TX 75460-9313

Mailing address

PO Box 732
Antlers, OK 74523-0732
Phone (580) 579-3314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170606003083 TX Practitioner - Physician Assistant 0749557114 Reassigns benefits to 2 organizations
I20211011000330 OK Practitioner - Physician Assistant 0749557114 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Choctaw Nation of OklahomaGroup PAC ID 1759294838, 271 clinicians
Ohh Physicians LLCGroup PAC ID 1759392079, 132 clinicians
Rowland Flatt ClinicGroup PAC ID 9830186824, 11 clinicians

Practice addresses (Care Compare)

1201 W Liberty Rd
Choctaw Nation Health Care Atoka
Atoka, OK 74525-1639
Phone (539) 316-6391

603 NE 2ND St
Antlers, OK 74523-2636
Phone (580) 298-3351

731 12TH Ave NW
Suite 103
Ardmore, OK 73401-5762
Phone (580) 220-6180

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4503OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Rowland Flatt Clinic CurrentSince Aug 4, 2022 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Nov 3, 2025 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Nov 3, 2025 Accepting new patients
Choctaw Nation of Oklahoma Current Accepting new patients
Pushmataha County Hospital Authority Past Accepting new patients

Locations

603 NE 2nd St
Antlers, OK 74523
Phone (580) 298-3351

1585 W Liberty Rd
Atoka, OK 74525
Phone (580) 889-1981

1300 E Martin Luther King Dr
Broken Bow, OK 74728
Phone (580) 208-2204

1405 E Kirk St
Hugo, OK 74743
Phone (580) 317-9500

410 N M St
Hugo, OK 74743
Phone (580) 326-7561

902 E Lincoln Rd
Idabel, OK 74745
Phone (580) 286-2600

1127 S George Nigh Expy
McAlester, OK 74501
Phone (918) 423-8400

109 Kerr Blvd
Poteau, OK 74953
Phone (918) 649-1100

2204 E Main St
Stigler, OK 74462
Phone (918) 967-9200

1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440

205 Dallas St
Talihina, OK 74571
Phone (918) 567-3636

Organizations & group practices 8

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1489363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1790226504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 732",
            "city": "ANTLERS",
            "state": "OK",
            "postal_code": "745230732",
            "telephone_number": "580-579-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 DESHONG DR",
            "city": "PARIS",
            "state": "TX",
            "postal_code": "754609313",
            "telephone_number": "903-785-4521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "LACEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-13",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paris, TX

Sources for this page

Verify at the official NPI Registry.