Tara Miranda Lewis, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1659 Issued in OK

Practice address

2510 Chickasaw Blvd
Ardmore, OK 73401-1341

Phone

(580) 226-8181

NPI assigned

Nov 5, 2007

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

• Tara Miranda Wade Former name

Medicare fee-for-service enrollment

Enrolled in OK, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Chickasaw Nation Division of Health

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923

  TX

  Medicare reassignment
• Long Term Care Specialists, Inc

  • Geriatric Medicine (Family Medicine) Physician
  • Oklahoma City, OK
  • NPI 1497761159
  Medicare reassignment
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment
• Mercy Hospital Healdton, Inc

  • Critical Access Hospital
  • Healdton, OK
  • NPI 1568615656
  Medicare reassignment
• Chickasaw Nation Division of Health

  • Primary Care Clinic/Center
  • Ardmore, OK
  • NPI 1730249186
  NPD
• Chickasaw Nation Division of Health

  • Home Health Agency
  • Ada, OK
  • NPI 1811739071
  NPD
• Mercy Hospital Healdton, Inc.

  • Rural Health Clinic/Center
  • Healdton, OK
  • NPI 1437467388
  NPD

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1962682104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 WARRIOR WAY",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203491",
            "telephone_number": "580-421-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 CHICKASAW BLVD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011341",
            "telephone_number": "580-226-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "TARA",
        "middle_name": "MIRANDA",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-05",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "WADE",
            "middle_name": "MIRANDA",
            "credential": "P.A.-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Savannah Lemons
• Suzann K Leskela, PHARMD
• Elizabeth Michelle Lette-Fortune, OT
• Kaitlin Lewis
• Kianna Lewis
• Zechaya Lewis
• Lifes Cycle Womens Care PC
• Lighthouse Behavioral Wellness Centers
• Lighthouse Behavioral Wellness Centers
• Lighthouse Behavioral Wellness Centers

• Physician Assistant in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.