JERAD SCOTT WAGNER (NPI# 1932448347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932448347 |
| Entity Type | Individual |
| Full Name | JERAD SCOTT WAGNER |
| Credential | PA-C |
| Practice Address |
921 14th Ave Nw Ardmore OK 73401-1837 |
| Practice Telephone | 5802235311 |
| Practice Fax Number | 5802238227 |
| Mailing Telephone | 5802235311 |
| Mailing Fax Number | 5802238227 |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2016-01-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2197 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | PHYSICIAN ASSISTANT LICENSE | 2197 | 01 |
| Street Address |
921 14TH AVE NW |
| City | ARDMORE |
| State | OK |
| Zip Code | 73401-1837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457331175 | Medical Arts Clinic of Ardmore Inc | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-01-19 |
| 1912395898 | Lisa Burton | Nurse Practitioner | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2014-12-31 |
| 1376703595 | Summer Kirby | Family Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2008-06-11 |
| 1487854642 | Derek Todd Landis | Pediatrics | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2007-07-24 |
| 1205929320 | Ashley V Kelley | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-10-02 |
| 1679595144 | Bobby J Ellis | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-07-24 |
| 1306889878 | Sallie J Walker | Nurse Practitioner | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-06-13 |
| 1235176629 | Wilfred S Gauthier | Surgery | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-06-02 |
| 1194779975 | Toribio C Velasquez | Internal Medicine | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-05-19 |
| 1114982527 | Mercy Health Services - Southern Oklahoma, LLC | Clinic/Center | 921 14th Ave Nw, Ardmore, OK 73401-1837 | 2006-04-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391452 | Abbie Deeann Mclemore | Nurse Practitioner | 915 10th Ave, Ardmore, OK 73401 | 2019-11-25 |
| 1790349991 | Shirley Denise Brown | Licensed Psychiatric Technician | 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 | 2019-04-24 |
| 1427512359 | Billy Joe Oshields | Case Manager/Care Coordinator | 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 | 2019-01-24 |
| 1174007595 | Tawnya Dawn Peery | Nurse Practitioner | 1108 W. Walnut Drive, Ardmore, OK 73401 | 2018-09-21 |
| 1679055016 | Teresa Marie Hernandez | Behavior Technician | 1219 K St. Nw, Ardmore, OK 73401 | 2018-09-01 |
| 1063991974 | Sawyer Rae Shamburger | Occupational Therapy Assistant | 208 North Praire St, Pilot Point, TX 73401 | 2018-08-10 |
| 1417473521 | Chelsye Bacon | Peer Specialist | 905 Holiday Drive, Ardmore, OK 73401 | 2017-08-21 |
| 1003279746 | Jeni Presley | Marriage & Family Therapist | Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 | 2016-03-31 |
| 1982080909 | Alison Hill | Pharmacist | 1111 N. Commerce, Ardmore, OK 73401 | 2015-07-31 |
| 1316346547 | Olivia Larae Carrell | Counselor | 15 Monroe Street Ne, Ardmore, OK 73401 | 2014-08-13 |
| Find all providers in zip 73401 | ||||
| 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 |
|---|---|---|---|---|
| 1477176147 | April Dawn Sullivan | Physician Assistant | 1111 Walnut Dr, Ardmore, OK 73401-2354 | 2020-05-28 |
| 1427594274 | Danielle Wheat | Physician Assistant | 908 N Rockford Rd Ste G, Ardmore, OK 73401-2541 | 2017-01-17 |
| 1316956998 | Shelby Lucas | Physician Assistant | 908 N Rockford Road, Suite A, Ardmore, OK 73401-2541 | 2006-08-05 |
| 1871558064 | Charles Donald Holmes | Physician Assistant | 1001 15th Ave Nw, Suite A, Ardmore, OK 73401-1810 | 2006-04-19 |
| 1912998857 | Julie Kaye Bryant | Physician Assistant | 2410 N Commerce St, Ardmore, OK 73401 | 2005-10-31 |
| 1083601868 | Robert Dean Hanna | Physician Assistant | 1505 N Commerce St, Ste 203, Ardmore, OK 73401-1859 | 2005-10-05 |
| 1447876826 | Kyndel Dillard | Physician Assistant | 1675 12th Ave Nw, Ardmore, OK 73401-1283 | 2020-06-22 |
| 1609232164 | Hope Robbins | Physician Assistant | 2410 N Commerce St, Ardmore, OK 73401-1356 | 2016-01-13 |
| 1245501105 | Aaron Spells | Physician Assistant | 915 10th Ave Nw, Ardmore, OK 73401-4025 | 2012-01-24 |
| 1659666428 | Stephen Vance Paul | Physician Assistant | 20 12th Ave Nw, Ardmore, OK 73401-5722 | 2011-06-09 |
| Find all providers in ARDMORE | ||||
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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.