WINDSOR PARK MEDICAL CLINIC (NPI# 1104070259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104070259 |
| Entity Type | Organization |
| Organization Name | WINDSOR PARK MEDICAL CLINIC |
| Practice Address |
2512 N Meridian Ave Oklahoma City OK 73107-1035 |
| Practice Telephone | 4056055415 |
| Practice Fax Number | 4056055310 |
| Mailing Telephone | 4056055415 |
| Mailing Fax Number | 4056055310 |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2008-11-14 |
| Authorized Official Name | STACY LOUISE FAGAN (PHYSICIAN ASSISTANT) |
| Authorized Official Telephone | 4056055415 |
| Authorized Official Credential | P.A.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1779 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184640112 | Windsor Park Medical Clinic | Family Medicine | 2512 N Meridian Ave, Oklahoma City, OK 73107-1035 | 2006-07-14 |
| Street Address |
2512 N MERIDIAN AVE |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73107-1035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184640112 | Windsor Park Medical Clinic | Family Medicine | 2512 N Meridian Ave, Oklahoma City, OK 73107-1035 | 2006-07-14 |
| 1073172607 | Kehdinga Nukuna | Nurse Practitioner | 2512 N Meridian Ave, Oklahoma City, OK 73107-1035 | 2019-06-07 |
| 1952649204 | Jill Whitney Frost | Physician Assistant | 2512 N Meridian Ave, Oklahoma City, OK 73107-1035 | 2013-01-22 |
| 1841444098 | Stacy Louise Fagan | Physician Assistant | 2512 N Meridian Ave, Oklahoma City, OK 73107-1035 | 2008-11-13 |
| 1699823617 | Windsor Park Medical Clinic, LLC | Family Medicine | 2512 N Meridian Ave, Oklahoma City, OK 73107-1035 | 2007-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144747999 | Ellen Rose Pochyly | Counselor | 2617 General Pershing Boulevard, Oklahoma City, OK 73107 | 2017-08-23 |
| 1609399906 | Carrie Ann Moore | Counselor | 2617 General Pershing Blvd., Oklahoma City, OK 73107 | 2017-07-19 |
| 1821511320 | Diana Lynn Spencer | Counselor | 2617generalpershingblvd, Oklahoma City, OK 73107 | 2017-07-18 |
| 1861859514 | Catherine Evans | Counselor | 500 N Meridian Ave Ste 409, Oklahoma City, OK 73107 | 2016-01-26 |
| 1871964551 | Kizzy Frazier | Student in an Organized Health Care Education/Training Program | 1233 N Warren Pl, Oklahoma City, OK 73107 | 2015-10-07 |
| 1538550629 | Oklahoma Department of Mental Health and Substance Abuse | Case Management | 2625 General Pershing Boulevard, Oklahoma City, OK 73107 | 2015-02-10 |
| 1952702276 | Andale Healthcare, LLC | Clinic/Center | 2305 N. Meridian, Oklahoma City, OK 73107 | 2014-09-05 |
| 1114339348 | John Walls | Psychologist | 2012 North Villa Avenue, Oklahoma City, OK 73107 | 2014-05-22 |
| 1376970517 | Latrice Warrior | Community/Behavioral Health | 2625 General Pershing Drive, Oklahoma City, OK 73107 | 2013-10-02 |
| 1326485541 | Debra Sue Vaughan | Counselor | 2617 Genral Pershing Blvd, Oklahoma City, OK 73107 | 2013-05-29 |
| Find all providers in zip 73107 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013517168 | Madeleine Hill | Physician Assistant | 5304 N Hudson Ave, Oklahoma City, OK 73118-6232 | 2020-10-28 |
| 1003414673 | Stephanie Ann Stephens | Physician Assistant | 5021 Eric Dr, Oklahoma City, OK 73135-4129 | 2020-10-15 |
| 1336786557 | Chad Tiaden | Physician Assistant | 940 Ne 13th St Ste 2300, Oklahoma City, OK 73104-5008 | 2019-12-06 |
| 1588209837 | Kathryn Lynn Lane | Physician Assistant | 737 Sw 157th St, Oklahoma City, OK 73170-7688 | 2019-11-11 |
| 1760025845 | Robert Eugene Curling | Physician Assistant | 3435 Nw 56th St Ste 909, Oklahoma City, OK 73112-4400 | 2019-10-22 |
| 1740831486 | Aliina Ann O'toole | Physician Assistant | 1200 Childrens Ave Ste 8305, Oklahoma City, OK 73104-4637 | 2019-09-24 |
| 1093375271 | Alison Suezan Barton | Physician Assistant | 13401 N Western Ave Ste 210, Oklahoma City, OK 73114-1410 | 2019-06-19 |
| 1376100750 | Katelyn Taylor Bant | Physician Assistant | 6001 S Sooner Rd, Ste A, Oklahoma City, OK 73135-5601 | 2019-05-21 |
| 1538726997 | Mariah Paige Melton | Physician Assistant | 4400 Hemingway Dr Apt 251, Oklahoma City, OK 73118-2241 | 2019-05-21 |
| 1336703123 | Soni Simer | Physician Assistant | 11601 Kingswick Dr, Oklahoma City, OK 73162-2918 | 2019-04-26 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.