Discovery Wellness LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

DISCOVERY WELLNESS LLC

Practice address

17625 Lead LN
Edmond, OK 73012-6959

Phone

(405) 210-1662

NPI assigned

Sep 23, 2015

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrew Blakeman

Title

Operations Manager

Phone

(405) 210-1662

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1932578762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17625 LEAD LN",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730126959",
            "telephone_number": "405-210-1662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17625 LEAD LN",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730126959",
            "telephone_number": "405-210-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISCOVERY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BLAKEMAN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "405-210-1662"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200294910A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA NURSING LISCENSE",
            "identifier": "78861",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Kyle Dill, DPT
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• Susan M Dimick, M.D.
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• Physician Assistant in Edmond, OK
• Providers in Edmond, OK by specialty
• Physician Assistant in Oklahoma

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