MS. MAISSA BAKER MITWALLI (NPI# 1689271041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689271041 |
| Entity Type | Individual |
| Full Name | MS. MAISSA BAKER MITWALLI |
| Credential | PA-C |
| Practice Address |
700 S Desert Palm Ave Broken Arrow OK 74012-8815 |
| Practice Telephone | 9186912019 |
| Mailing Telephone | 9186912019 |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2020-11-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
700 S DESERT PALM AVE |
| City | BROKEN ARROW |
| State | OK |
| Zip Code | 74012-8815 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154949139 | Bonnie Jordan James | Pharmacist | 915 E Kenosha St, Broken Arrow, OK 74012 | 2020-07-07 |
| 1548814874 | Flawless Smile Dentistry of Ba Pllc | Dentist | 2319 N. 9th Street, Broken Arrow, OK 74012 | 2019-07-25 |
| 1780236653 | Carefirst Pharmacy Inc. | Pharmacy | 2530 N. Elm Pl., Broken Arrow, OK 74012 | 2019-07-11 |
| 1043871213 | Stacy Lynn Mitchell | Counselor | 2035 W. Houson St., Suite A, Broken Arrow, OK 74012 | 2019-06-27 |
| 1497319297 | Sara Hart | Internal Medicine | 420 W. Stone Wood Drive, Broken Arrow, OK 74012 | 2019-04-26 |
| 1699262386 | Fulps Family Eye Care, LLC | Optometrist | 3300 S Aspen Ave Ste D, Broken Arrow, OK 74012 | 2018-04-18 |
| 1598284358 | Stephanie Sue Mcquarters | Clinical Medical Laboratory | 1840 South Lion Avenue, Broken Arrow, OK 74012 | 2017-09-13 |
| 1477072460 | Kama Rae Gettings | Nurse Practitioner | 4623 W. Kenosha St, Broken Arrow, OK 74012 | 2017-09-12 |
| 1689196727 | Kristen Sherie' Snyder | Case Manager/Care Coordinator | 1324 North Umbrella Avenue, Broken Arrow, OK 74012 | 2017-07-11 |
| 1699216754 | Hillside Wellness Plllp | Chiropractor | 2311 N 9th St, Suite 101, Broken Arrow, OK 74012 | 2017-03-09 |
| Find all providers in zip 74012 | ||||
| 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 |
|---|---|---|---|---|
| 1629579792 | Thuc-vi Nguyen | Physician Assistant | 5808 W Twin Oaks St, Broken Arrow, OK 74011-1573 | 2018-02-23 |
| 1114262474 | Natalie Maguire Scardino | Physician Assistant | 2950 S Elm Pl Ste 152, Broken Arrow, OK 74012 | 2012-11-27 |
| 1033480538 | Patricia Joyce Iven | Physician Assistant | 1130 E. Lansing, Broken Arrow, OK 74012 | 2012-01-16 |
| 1235265646 | Eric Steven Franklin | Physician Assistant | 800 W Boise Cir Ste 120, Broken Arrow, OK 74012-4972 | 2007-02-27 |
| 1164584868 | Jennifer L. Rau | Physician Assistant | 8509 S Fir Ave, Broken Arrow, OK 74011-1220 | 2006-12-16 |
| 1043280100 | Ronda L Cherry | Physician Assistant | 2950 S Elm Pl Ste 160, Broken Arrow, OK 74012-7816 | 2006-01-23 |
| 1427033620 | Anthony Barbettini | Physician Assistant | 800 W Boise Cir Ste 160, Broken Arrow, OK 74012 | 2005-12-09 |
| 1972154185 | Karlee Campbell Van Dam | Physician Assistant | 5050 E Kenosha St, Broken Arrow, OK 74014-6711 | 2019-09-28 |
| 1215400767 | Jeffrey Hillhouse | Physician Assistant | 2950 S Elm Pl Ste 120, Broken Arrow, OK 74012-7816 | 2019-01-08 |
| 1487151106 | Stephani Brooke Brisbin | Physician Assistant | 2950 S Elm Pl, Broken Arrow, OK 74012-7877 | 2018-04-09 |
| Find all providers in BROKEN ARROW | ||||
| City | BROKEN ARROW |
| Zip Code | 74012 |
Please comment or provide details below to improve the information on MS. MAISSA BAKER MITWALLI.
| 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.