| Creek Nation Health System | |
|
2900 N Main St, Muskogee, OK 74401-4078 | |
| (918) 346-7833 | |
| Not Available |
| Full Name | Creek Nation Health System |
|---|---|
| Type | Facility |
| Speciality | Clinic/center |
| Location | 2900 N Main St, Muskogee, Oklahoma |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366593923 | NPI | - | NPPES |
| Provider Name | Daniel Langley |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1659361541 PECOS PAC ID: 2769386556 Enrollment ID: I20031124000085 |
| Provider Name | Joseph Braden |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275523011 PECOS PAC ID: 0345144937 Enrollment ID: I20031125000363 |
| Provider Name | Sean Smith |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1730169350 PECOS PAC ID: 4789588179 Enrollment ID: I20031126000450 |
| Provider Name | John B Marlar |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316923576 PECOS PAC ID: 7719883099 Enrollment ID: I20031209000066 |
| Provider Name | Deborah L Greubel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316917776 PECOS PAC ID: 6305747825 Enrollment ID: I20040117000102 |
| Provider Name | Marvin Jin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679512974 PECOS PAC ID: 4082516414 Enrollment ID: I20040124000333 |
| Provider Name | Kenneth E Phillips |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215995360 PECOS PAC ID: 8729972872 Enrollment ID: I20040210001116 |
| Provider Name | Bart M Rowlett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104945526 PECOS PAC ID: 5092602102 Enrollment ID: I20040303000430 |
| Provider Name | William E Wood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790792711 PECOS PAC ID: 9133018559 Enrollment ID: I20040313000184 |
| Provider Name | James D Campbell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932185212 PECOS PAC ID: 9335042381 Enrollment ID: I20040313000748 |
| Provider Name | Charlene Franklin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1841292331 PECOS PAC ID: 7315837374 Enrollment ID: I20040316000358 |
| Provider Name | Kimberly Gage |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255321006 PECOS PAC ID: 9133010564 Enrollment ID: I20040323001942 |
| Provider Name | Shelly D Faubion |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043292493 PECOS PAC ID: 2062323660 Enrollment ID: I20040331001043 |
| Provider Name | Kevin G Bradley |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1609971241 PECOS PAC ID: 4981696465 Enrollment ID: I20040402000657 |
| Provider Name | Eric Auerbach |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1881664399 PECOS PAC ID: 7416940648 Enrollment ID: I20040405001177 |
| Provider Name | John Migliaccio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457303430 PECOS PAC ID: 9638164239 Enrollment ID: I20040414001669 |
| Provider Name | Julie Knox |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467519496 PECOS PAC ID: 1052307063 Enrollment ID: I20040423001205 |
| Provider Name | Carl N Griffin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548365117 PECOS PAC ID: 3072503671 Enrollment ID: I20040515000166 |
| Provider Name | Nancy Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235190448 PECOS PAC ID: 9133101363 Enrollment ID: I20040602000973 |
| Provider Name | Karen Gold |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518925692 PECOS PAC ID: 9638151129 Enrollment ID: I20040610001487 |
| Provider Name | Harry Fisher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174556054 PECOS PAC ID: 1355325044 Enrollment ID: I20040618000290 |
| Provider Name | Sang H Lee |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003802182 PECOS PAC ID: 3375521644 Enrollment ID: I20040713000023 |
| Provider Name | John S Dennis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871584060 PECOS PAC ID: 3173594389 Enrollment ID: I20040803000032 |
| Provider Name | Igor Shendrik |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1982623930 PECOS PAC ID: 6002887668 Enrollment ID: I20040805000659 |
| Provider Name | Daniel E Wildes |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932163565 PECOS PAC ID: 7113998071 Enrollment ID: I20040806000158 |
| Provider Name | Billy C Beets |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609894419 PECOS PAC ID: 6305819970 Enrollment ID: I20040819000362 |
| Provider Name | Stuart Hoff |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932212578 PECOS PAC ID: 3072587567 Enrollment ID: I20040826000005 |
| Provider Name | James Kennedye |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639100035 PECOS PAC ID: 2466427752 Enrollment ID: I20040831000300 |
| Provider Name | Jack S Aldridge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700878378 PECOS PAC ID: 8921074683 Enrollment ID: I20040903000919 |
| Provider Name | Clayton Flanary |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740215680 PECOS PAC ID: 9638145865 Enrollment ID: I20040908001199 |
| Provider Name | Jay Brent Wheeler |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1144279456 PECOS PAC ID: 0446228035 Enrollment ID: I20040921001218 |
| Provider Name | Robert N Jarman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992765390 PECOS PAC ID: 1052372968 Enrollment ID: I20041025000289 |
| Provider Name | Terry A Bush |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1760407704 PECOS PAC ID: 2769444520 Enrollment ID: I20041103000395 |
| Provider Name | Berry E Winn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225028780 PECOS PAC ID: 8325020266 Enrollment ID: I20041118000372 |
| Provider Name | Alfred C Degner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891755294 PECOS PAC ID: 4082675996 Enrollment ID: I20041214000210 |
| Provider Name | Felino A Pascual |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801877055 PECOS PAC ID: 6002801834 Enrollment ID: I20050127000464 |
| Provider Name | George E Erbacher |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326039801 PECOS PAC ID: 5991755829 Enrollment ID: I20050127000708 |
| Provider Name | Sheila Malone Taber |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447241971 PECOS PAC ID: 1557311495 Enrollment ID: I20050127000816 |
| Provider Name | Dean Roy Fullingim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770574253 PECOS PAC ID: 5193710929 Enrollment ID: I20050127000975 |
| Provider Name | Christian S Hanson |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1083684302 PECOS PAC ID: 7810940947 Enrollment ID: I20050301000206 |
| Provider Name | Timothy T Mccay |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245221761 PECOS PAC ID: 2961456538 Enrollment ID: I20050307000314 |
| Provider Name | Jorge A Gonzalez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073567392 PECOS PAC ID: 2264487271 Enrollment ID: I20050316000010 |
| Provider Name | Robert A Wieck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972591980 PECOS PAC ID: 2668410051 Enrollment ID: I20050418000351 |
| Provider Name | Tom A Hamilton |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1972593622 PECOS PAC ID: 1658319975 Enrollment ID: I20050418001315 |
| Provider Name | Larry D Bowler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316987522 PECOS PAC ID: 0941252225 Enrollment ID: I20050419001477 |
| Provider Name | Christopher M Puls |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376514125 PECOS PAC ID: 1850353392 Enrollment ID: I20050425000817 |
| Provider Name | Jahangir Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265590889 PECOS PAC ID: 8123069630 Enrollment ID: I20050516000235 |
| Provider Name | Bryan A Lucenta |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1699886077 PECOS PAC ID: 9638111834 Enrollment ID: I20050527000311 |
| Provider Name | Jerry Childs |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639137409 PECOS PAC ID: 1658307194 Enrollment ID: I20050715000131 |
| Provider Name | Nina C Jones |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003877754 PECOS PAC ID: 6901833367 Enrollment ID: I20050718001044 |
| Provider Name | Laura M Young |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720048267 PECOS PAC ID: 9436109477 Enrollment ID: I20050727000779 |
| Provider Name | Julie H Dudley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841318771 PECOS PAC ID: 1456389535 Enrollment ID: I20050729000845 |
| Provider Name | Oliver Cvitanic |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538267208 PECOS PAC ID: 2567490204 Enrollment ID: I20050803000006 |
| Provider Name | Stephen Fransen |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1750358107 PECOS PAC ID: 3971576935 Enrollment ID: I20050822001370 |
| Provider Name | Randy Niblett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154304434 PECOS PAC ID: 2961392782 Enrollment ID: I20050823000056 |
| Provider Name | Billy D Crow |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1194832329 PECOS PAC ID: 4183668593 Enrollment ID: I20050830000680 |
| Provider Name | Blake Edward Weaver |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497785893 PECOS PAC ID: 6103890975 Enrollment ID: I20050913001258 |
| Provider Name | Ulysses Bowler |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1942290788 PECOS PAC ID: 2163447731 Enrollment ID: I20051012000876 |
| Provider Name | Diane M Reynolds |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932197183 PECOS PAC ID: 2062438757 Enrollment ID: I20051021000471 |
| Provider Name | James R Patterson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1225125966 PECOS PAC ID: 4284654229 Enrollment ID: I20051205000882 |
| Provider Name | Lisa D Johnson |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1558386987 PECOS PAC ID: 1254358799 Enrollment ID: I20051212000300 |
| Provider Name | Bradley Christianson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1134178411 PECOS PAC ID: 8527950583 Enrollment ID: I20051223000063 |
| Provider Name | Kenneth E Mann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851398713 PECOS PAC ID: 7113985441 Enrollment ID: I20060120000535 |
| Provider Name | Schuyler T Steelberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528052875 PECOS PAC ID: 6608789961 Enrollment ID: I20060125000828 |
| Provider Name | Arthur Harold Hulbert |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1578890281 PECOS PAC ID: 1759395825 Enrollment ID: I20060128000046 |
| Provider Name | Carla J Jones |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1487691234 PECOS PAC ID: 3870546047 Enrollment ID: I20060224000097 |
| Provider Name | Jeffrey Dixon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669463865 PECOS PAC ID: 4082680962 Enrollment ID: I20060301000447 |
| Provider Name | Sidney Gatzman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730397662 PECOS PAC ID: 4486669637 Enrollment ID: I20060301000815 |
| Provider Name | Stephanie Holt |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1013930148 PECOS PAC ID: 8224044813 Enrollment ID: I20060309000488 |
| Provider Name | Myeong S Yoon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497722342 PECOS PAC ID: 0042227266 Enrollment ID: I20060314000156 |
| Provider Name | Craig Allen Kennedy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356332555 PECOS PAC ID: 0941219687 Enrollment ID: I20060407000445 |
| Provider Name | Kelly Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871554139 PECOS PAC ID: 6002824323 Enrollment ID: I20060719000251 |
| Provider Name | Mark A Brandenburg |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588621627 PECOS PAC ID: 3375556921 Enrollment ID: I20060726000192 |
| Provider Name | Jeffrey A Johnson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356386528 PECOS PAC ID: 2668406935 Enrollment ID: I20060817000644 |
| Provider Name | Cindi Starkey |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1578580494 PECOS PAC ID: 3072517200 Enrollment ID: I20060831000132 |
| Provider Name | Lawrence E Vark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063445930 PECOS PAC ID: 2567400674 Enrollment ID: I20060905000593 |
| Provider Name | Soledad Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205851235 PECOS PAC ID: 6709880644 Enrollment ID: I20060906000542 |
| Provider Name | John D Walton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326096850 PECOS PAC ID: 3375546054 Enrollment ID: I20060911000568 |
| Provider Name | Henry D Haskell |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1619994522 PECOS PAC ID: 6103829858 Enrollment ID: I20060916000051 |
| Provider Name | Linda K Blunt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699796862 PECOS PAC ID: 4486659091 Enrollment ID: I20061003000273 |
| Provider Name | Adelaide L Priester |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1922107648 PECOS PAC ID: 6507863552 Enrollment ID: I20061103000467 |
| Provider Name | Kenneth J Kirk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073521332 PECOS PAC ID: 1951309301 Enrollment ID: I20061117000447 |
| Provider Name | William Knight Gray |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891786000 PECOS PAC ID: 6709852684 Enrollment ID: I20070108000088 |
| Provider Name | James V Rooks |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1841269792 PECOS PAC ID: 7012918915 Enrollment ID: I20070119000199 |
| Provider Name | Eric Woolley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043231749 PECOS PAC ID: 5092713008 Enrollment ID: I20070212000693 |
| Provider Name | Ann E Campbell |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699850800 PECOS PAC ID: 7214030311 Enrollment ID: I20070309000493 |
| Provider Name | Angela M Mcguire |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1053492256 PECOS PAC ID: 9436254307 Enrollment ID: I20070420000548 |
| Provider Name | Laura L Arrowsmith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083654800 PECOS PAC ID: 9638123631 Enrollment ID: I20070531000016 |
| Provider Name | Bruce Hodson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083724074 PECOS PAC ID: 8921106071 Enrollment ID: I20070613000314 |
| Provider Name | Jason Ellen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1962405928 PECOS PAC ID: 7214036821 Enrollment ID: I20070622000222 |
| Provider Name | John B White |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063453223 PECOS PAC ID: 8325148034 Enrollment ID: I20070711000102 |
| Provider Name | Anna Wanahita |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073650537 PECOS PAC ID: 7214037860 Enrollment ID: I20070711000514 |
| Provider Name | Ryan Hendren |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1205963675 PECOS PAC ID: 6608977814 Enrollment ID: I20070718000329 |
| Provider Name | Jerry J Castleberry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417919762 PECOS PAC ID: 6305895178 Enrollment ID: I20070724000060 |
| Provider Name | Brandon A Conkling |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134273378 PECOS PAC ID: 8820189616 Enrollment ID: I20070808000545 |
| Provider Name | Matt Blankenship |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902950165 PECOS PAC ID: 9133211428 Enrollment ID: I20070816000143 |
| Provider Name | Catherine M Remer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750301057 PECOS PAC ID: 0042302929 Enrollment ID: I20070823000228 |
| Provider Name | Walter A Lajara-nanson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1528050283 PECOS PAC ID: 1951335736 Enrollment ID: I20070825000109 |
| Provider Name | Michelle M Ponder |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447399415 PECOS PAC ID: 4880787217 Enrollment ID: I20070830000600 |
| Provider Name | Russell Anderson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114939733 PECOS PAC ID: 9032116314 Enrollment ID: I20070910000266 |
| Provider Name | Anton Surja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437296001 PECOS PAC ID: 0749373496 Enrollment ID: I20070911000528 |
| Provider Name | Karen Boland |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1356558118 PECOS PAC ID: 7810971710 Enrollment ID: I20070928000149 |
| Provider Name | Stanley J Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487677381 PECOS PAC ID: 5092801423 Enrollment ID: I20071017000469 |
| Provider Name | David L Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083637961 PECOS PAC ID: 7911093265 Enrollment ID: I20071017000741 |
| Provider Name | Sharon A Iverson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1649462052 PECOS PAC ID: 7810083045 Enrollment ID: I20071018000471 |
| Provider Name | Brandi L Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1922299700 PECOS PAC ID: 5193811073 Enrollment ID: I20071024000103 |
| Provider Name | Debra Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871786376 PECOS PAC ID: 9436246162 Enrollment ID: I20071029000156 |
| Provider Name | Anna I Stidham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114066180 PECOS PAC ID: 5991884017 Enrollment ID: I20080430000758 |
| Provider Name | John Romano |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1124021191 PECOS PAC ID: 1759363310 Enrollment ID: I20080501000324 |
| Provider Name | Delana Westman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1336260652 PECOS PAC ID: 1557431913 Enrollment ID: I20080528000642 |
| Provider Name | Edward Martin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1982674719 PECOS PAC ID: 8224931241 Enrollment ID: I20080716000260 |
| Provider Name | Suraj Suku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891833505 PECOS PAC ID: 9133293178 Enrollment ID: I20080808000395 |
| Provider Name | Judith Wolfstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013914456 PECOS PAC ID: 0345135232 Enrollment ID: I20080811000449 |
| Provider Name | Roger Desprez |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154391993 PECOS PAC ID: 2860395886 Enrollment ID: I20080828000545 |
| Provider Name | Elizabeth K Dolin |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1861673493 PECOS PAC ID: 1153497011 Enrollment ID: I20080829000398 |
| Provider Name | Justin Thankachan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851433221 PECOS PAC ID: 8123186103 Enrollment ID: I20081020000468 |
| Provider Name | Olakunle D Ajanaku |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1740270305 PECOS PAC ID: 8224191499 Enrollment ID: I20090114000352 |
| Provider Name | William K Tordzro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780688317 PECOS PAC ID: 7911892302 Enrollment ID: I20090127000318 |
| Provider Name | Ralph Noah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669458741 PECOS PAC ID: 6800966284 Enrollment ID: I20090203000191 |
| Provider Name | Cristin M Bruns |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1053364224 PECOS PAC ID: 2961457668 Enrollment ID: I20090219000483 |
| Provider Name | Thomas J Newman |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457547051 PECOS PAC ID: 0042305302 Enrollment ID: I20090316000557 |
| Provider Name | Jeffrey Carter Melton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780823104 PECOS PAC ID: 9436206448 Enrollment ID: I20090408000670 |
| Provider Name | Randolph C Elliott |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558395038 PECOS PAC ID: 0042367591 Enrollment ID: I20090420000680 |
| Provider Name | Jason Pack |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861549743 PECOS PAC ID: 3375623887 Enrollment ID: I20090423000718 |
| Provider Name | Jason Whiteley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1669496725 PECOS PAC ID: 6901796838 Enrollment ID: I20090605000505 |
| Provider Name | Damon L Brooks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558583963 PECOS PAC ID: 4587715354 Enrollment ID: I20090708000227 |
| Provider Name | Jeremy Scott Fullingim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255537304 PECOS PAC ID: 5092867762 Enrollment ID: I20090710000584 |
| Provider Name | Kelly Cole |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699958157 PECOS PAC ID: 0648322024 Enrollment ID: I20090715000649 |
| Provider Name | Craig B Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467411645 PECOS PAC ID: 6406908425 Enrollment ID: I20090722000095 |
| Provider Name | Michael C West |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881655678 PECOS PAC ID: 6709845282 Enrollment ID: I20090908000047 |
| Provider Name | Lance Frye |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1649321415 PECOS PAC ID: 9931002847 Enrollment ID: I20090917000347 |
| Provider Name | Jeremy Salas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447447487 PECOS PAC ID: 0345386934 Enrollment ID: I20091013000378 |
| Provider Name | Anthony Haney |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1760415590 PECOS PAC ID: 6406859420 Enrollment ID: I20091029000252 |
| Provider Name | Michael Newnam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851355812 PECOS PAC ID: 9638233703 Enrollment ID: I20091111000565 |
| Provider Name | Ronald Kingsley |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1962471326 PECOS PAC ID: 2668510397 Enrollment ID: I20091117000413 |
| Provider Name | David D Garrett |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1265412613 PECOS PAC ID: 6406995430 Enrollment ID: I20091203000447 |
| Provider Name | Jacqueline Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801874805 PECOS PAC ID: 5597807313 Enrollment ID: I20100116000193 |
| Provider Name | Emil J Schelbar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1124053624 PECOS PAC ID: 6204863178 Enrollment ID: I20100129000523 |
| Provider Name | Samuel B Hancock |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063672608 PECOS PAC ID: 3577699073 Enrollment ID: I20100408000359 |
| Provider Name | Jeff Scott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649245929 PECOS PAC ID: 7517031297 Enrollment ID: I20100428000769 |
| Provider Name | Walter Boomer |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1578598074 PECOS PAC ID: 8022045996 Enrollment ID: I20100430000047 |
| Provider Name | Meredith Gatzemeyer |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1467783282 PECOS PAC ID: 6305974999 Enrollment ID: I20100430000541 |
| Provider Name | Carla Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952432007 PECOS PAC ID: 0749319994 Enrollment ID: I20100526000352 |
| Provider Name | Hooby P Yoon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508066473 PECOS PAC ID: 4486705779 Enrollment ID: I20100729000937 |
| Provider Name | Bradley Britton |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1033112016 PECOS PAC ID: 4486639317 Enrollment ID: I20100819001118 |
| Provider Name | David Wilkett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922080860 PECOS PAC ID: 1557304383 Enrollment ID: I20100825001172 |
| Provider Name | Christian D Clark |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1649223710 PECOS PAC ID: 4082627468 Enrollment ID: I20100903000246 |
| Provider Name | Jeannette C Power |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1295927234 PECOS PAC ID: 9234254301 Enrollment ID: I20100913000687 |
| Provider Name | Douglas B Kliewer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174518906 PECOS PAC ID: 9335127257 Enrollment ID: I20100927000055 |
| Provider Name | Markham L Nightengale |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1144215971 PECOS PAC ID: 6901830025 Enrollment ID: I20100927000063 |
| Provider Name | Patrick R Volak |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174518336 PECOS PAC ID: 5496733313 Enrollment ID: I20100927000074 |
| Provider Name | Thomas R Todd |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619919487 PECOS PAC ID: 2163474412 Enrollment ID: I20100929000374 |
| Provider Name | James O Palmer |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1689696767 PECOS PAC ID: 6305867490 Enrollment ID: I20101007001145 |
| Provider Name | Paul Stanton |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1407841794 PECOS PAC ID: 7416935333 Enrollment ID: I20101008000629 |
| Provider Name | Paul L Gelven |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1851318554 PECOS PAC ID: 9133127970 Enrollment ID: I20101014000110 |
| Provider Name | Brent D Hartsell |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1265459960 PECOS PAC ID: 8921084070 Enrollment ID: I20101014001424 |
| Provider Name | Steven J Casner |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1427075225 PECOS PAC ID: 2264453372 Enrollment ID: I20101015000848 |
| Provider Name | Christos Vassiliou |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053567784 PECOS PAC ID: 8820120454 Enrollment ID: I20101027001348 |
| Provider Name | Tammy Battaglia |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1801813696 PECOS PAC ID: 7416955257 Enrollment ID: I20101029001275 |
| Provider Name | Brian J Bock |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1922020213 PECOS PAC ID: 8224059316 Enrollment ID: I20101109001183 |
| Provider Name | Therron Samuel Nichols |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1962512830 PECOS PAC ID: 4385839455 Enrollment ID: I20101115000808 |
| Provider Name | Bert Eric Blackwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649221177 PECOS PAC ID: 3072709989 Enrollment ID: I20101117001567 |
| Provider Name | Ronald Stephen Pritchard |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417998774 PECOS PAC ID: 2668426578 Enrollment ID: I20110106000965 |
| Provider Name | Dianna M Willis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376641316 PECOS PAC ID: 9032308713 Enrollment ID: I20110111000854 |
| Provider Name | Benjamin Kamp |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1922266121 PECOS PAC ID: 4486833290 Enrollment ID: I20110126000398 |
| Provider Name | Derek Matheson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780765719 PECOS PAC ID: 2668651118 Enrollment ID: I20110128001014 |
| Provider Name | Joshua Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740596030 PECOS PAC ID: 2466633136 Enrollment ID: I20110301000387 |
| Provider Name | Michael Chad Chamberlain |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1366757387 PECOS PAC ID: 8921281023 Enrollment ID: I20110328000526 |
| Provider Name | Robert Lee |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1114941820 PECOS PAC ID: 5294915021 Enrollment ID: I20110330000204 |
| Provider Name | Bette Bischoff Glidewell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134309933 PECOS PAC ID: 5890979264 Enrollment ID: I20110408000270 |
| Provider Name | Carl E Miller |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1194991828 PECOS PAC ID: 0042335234 Enrollment ID: I20110505000364 |
| Provider Name | Jess C Parker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063688232 PECOS PAC ID: 9638242167 Enrollment ID: I20110531000699 |
| Provider Name | Michelle Carter |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033283809 PECOS PAC ID: 5193903995 Enrollment ID: I20110627000365 |
| Provider Name | Christopher B Simic |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477871531 PECOS PAC ID: 6901939958 Enrollment ID: I20110823000623 |
| Provider Name | Allan Larance Suttle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861654097 PECOS PAC ID: 2860663457 Enrollment ID: I20110910002927 |
| Provider Name | Vinay A Shah |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1013951409 PECOS PAC ID: 2567513492 Enrollment ID: I20110910002929 |
| Provider Name | Imad Uddin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245498906 PECOS PAC ID: 3870764285 Enrollment ID: I20110915000274 |
| Provider Name | Stephen A Back |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639302060 PECOS PAC ID: 3476723594 Enrollment ID: I20111026000848 |
| Provider Name | Pedro L Cardich |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558312280 PECOS PAC ID: 6608838586 Enrollment ID: I20111101000362 |
| Provider Name | George Michael Jennings |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144392804 PECOS PAC ID: 3870768864 Enrollment ID: I20111201000689 |
| Provider Name | Ashok Kache |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1487751004 PECOS PAC ID: 4183891849 Enrollment ID: I20120120000057 |
| Provider Name | William R Saunders |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992745509 PECOS PAC ID: 2163489956 Enrollment ID: I20120213000523 |
| Provider Name | Melonie King |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811216567 PECOS PAC ID: 8022276997 Enrollment ID: I20120223000243 |
| Provider Name | Harold L Bolnick |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1346205549 PECOS PAC ID: 1951215417 Enrollment ID: I20120411000280 |
| Provider Name | James Richard Taylor |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1760406896 PECOS PAC ID: 6608897723 Enrollment ID: I20120516000733 |
| Provider Name | Patrick B O Hayre |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518134352 PECOS PAC ID: 2264695402 Enrollment ID: I20120525000067 |
| Provider Name | Leila Danielle See |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013164268 PECOS PAC ID: 6800059064 Enrollment ID: I20120525000311 |
| Provider Name | Jeffrey W Shelton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194864074 PECOS PAC ID: 7719141639 Enrollment ID: I20120605000614 |
| Provider Name | Erica Starkey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780839555 PECOS PAC ID: 0840455614 Enrollment ID: I20120628000293 |
| Provider Name | Stanley Kyle Zimmerman |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1861614737 PECOS PAC ID: 3173788973 Enrollment ID: I20120628000603 |
| Provider Name | Mathew Good |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346469582 PECOS PAC ID: 8224293931 Enrollment ID: I20120703000097 |
| Provider Name | Kanwaljit S Aulakh |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1376790329 PECOS PAC ID: 8325203896 Enrollment ID: I20120706000628 |
| Provider Name | Catherine Cudnoski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821225483 PECOS PAC ID: 9537324926 Enrollment ID: I20120710000636 |
| Provider Name | Jason Stratton |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1770740524 PECOS PAC ID: 7719143916 Enrollment ID: I20120716000143 |
| Provider Name | Jeffrey Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336451269 PECOS PAC ID: 4183880271 Enrollment ID: I20120717000522 |
| Provider Name | Pavankumar Bommasamudram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639306293 PECOS PAC ID: 3779749478 Enrollment ID: I20120725000093 |
| Provider Name | Miranda Johnson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881872539 PECOS PAC ID: 3577729177 Enrollment ID: I20120726000265 |
| Provider Name | Veronica Avila |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316174964 PECOS PAC ID: 5294991725 Enrollment ID: I20120726000749 |
| Provider Name | Philip E Whitlow |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1679799027 PECOS PAC ID: 0941466403 Enrollment ID: I20120727000283 |
| Provider Name | Huy Quoc Luu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124318985 PECOS PAC ID: 9830355338 Enrollment ID: I20120727000658 |
| Provider Name | Kimberlee R Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518100171 PECOS PAC ID: 8527214840 Enrollment ID: I20120801000856 |
| Provider Name | Michelle S Wells |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699989509 PECOS PAC ID: 9032365606 Enrollment ID: I20120814000480 |
| Provider Name | Michael John Boger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245517473 PECOS PAC ID: 1052568110 Enrollment ID: I20120823000800 |
| Provider Name | Michael R Phillips |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1619904513 PECOS PAC ID: 4385540160 Enrollment ID: I20120913000756 |
| Provider Name | Wesley S Dunn |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1073765632 PECOS PAC ID: 9234388794 Enrollment ID: I20120927000554 |
| Provider Name | Genevieve Dulan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033391370 PECOS PAC ID: 5991957656 Enrollment ID: I20121205000012 |
| Provider Name | Bilal Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073859443 PECOS PAC ID: 3779735022 Enrollment ID: I20121212000474 |
| Provider Name | Wesley Alan Updike |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053623884 PECOS PAC ID: 9931357639 Enrollment ID: I20130205000361 |
| Provider Name | Aliyeah Roper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386955532 PECOS PAC ID: 8224295779 Enrollment ID: I20130212000266 |
| Provider Name | Carole M Dentino |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689652869 PECOS PAC ID: 4981661592 Enrollment ID: I20130315000305 |
| Provider Name | Shawn D Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043214497 PECOS PAC ID: 6204877079 Enrollment ID: I20130404000155 |
| Provider Name | Marcus J Fidel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306983218 PECOS PAC ID: 3779729942 Enrollment ID: I20130412000157 |
| Provider Name | Jesse L Hatfield |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275822298 PECOS PAC ID: 3274779822 Enrollment ID: I20130426000267 |
| Provider Name | Jonathon D Kirkland |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639315260 PECOS PAC ID: 4789823139 Enrollment ID: I20130617000277 |
| Provider Name | Loren Kierl |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336438027 PECOS PAC ID: 4385883529 Enrollment ID: I20130618000833 |
| Provider Name | Garrett Taylor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083906143 PECOS PAC ID: 1850530973 Enrollment ID: I20130621000488 |
| Provider Name | Tamara C Newcomb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467614248 PECOS PAC ID: 7214092329 Enrollment ID: I20130702000694 |
| Provider Name | Korey Intfen Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548508542 PECOS PAC ID: 5294976684 Enrollment ID: I20130727000092 |
| Provider Name | Lauren Harjo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447562301 PECOS PAC ID: 8729229968 Enrollment ID: I20130730000744 |
| Provider Name | Eric Avery Reddick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225354012 PECOS PAC ID: 2668613639 Enrollment ID: I20130802000589 |
| Provider Name | James N Pham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306089578 PECOS PAC ID: 4284876558 Enrollment ID: I20130815000743 |
| Provider Name | Catherine E. Porter |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154564409 PECOS PAC ID: 9537302740 Enrollment ID: I20130906000343 |
| Provider Name | Stephen Mikus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598086050 PECOS PAC ID: 7719121938 Enrollment ID: I20130910000128 |
| Provider Name | Madison L Collins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801188248 PECOS PAC ID: 9537303599 Enrollment ID: I20130913000513 |
| Provider Name | Trang H Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790006591 PECOS PAC ID: 6406007848 Enrollment ID: I20130917000291 |
| Provider Name | Emily L Bruce |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1629410105 PECOS PAC ID: 1759525314 Enrollment ID: I20130920000504 |
| Provider Name | Meagan Leigh Brady |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699091553 PECOS PAC ID: 1850535378 Enrollment ID: I20130923000471 |
| Provider Name | Myra L Berry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942504378 PECOS PAC ID: 7012141344 Enrollment ID: I20130927000623 |
| Provider Name | Emily Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174814727 PECOS PAC ID: 6305073792 Enrollment ID: I20131210000963 |
| Provider Name | Paula F Guinnip |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1023239720 PECOS PAC ID: 5395723761 Enrollment ID: I20140111000036 |
| Provider Name | Monica Winford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679810295 PECOS PAC ID: 3971731886 Enrollment ID: I20140122000258 |
| Provider Name | Kendra D Round |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033459763 PECOS PAC ID: 6103065263 Enrollment ID: I20140211000453 |
| Provider Name | Steve Kim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1467698324 PECOS PAC ID: 6901036763 Enrollment ID: I20140224001432 |
| Provider Name | Katelynne Jean Yow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265854624 PECOS PAC ID: 0042441396 Enrollment ID: I20140329000280 |
| Provider Name | Brandon K Hatton |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1437572070 PECOS PAC ID: 0345472379 Enrollment ID: I20140407000475 |
| Provider Name | Amanda Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194165258 PECOS PAC ID: 8224265103 Enrollment ID: I20140430000861 |
| Provider Name | Nicholas Bull |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487968756 PECOS PAC ID: 6507099389 Enrollment ID: I20140501000763 |
| Provider Name | Brooke White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558679035 PECOS PAC ID: 4688807464 Enrollment ID: I20140501000788 |
| Provider Name | Amanda Iskey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053743567 PECOS PAC ID: 4082847405 Enrollment ID: I20140508001492 |
| Provider Name | Derek Knotts |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235497363 PECOS PAC ID: 2769605013 Enrollment ID: I20140514001121 |
| Provider Name | Peter J Mostert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326346875 PECOS PAC ID: 2860635844 Enrollment ID: I20140529001743 |
| Provider Name | Derek Johnson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1194024216 PECOS PAC ID: 8628292851 Enrollment ID: I20140610000724 |
| Provider Name | Bobbi L Mangrum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720359318 PECOS PAC ID: 1355565268 Enrollment ID: I20140617000020 |
| Provider Name | Jeffery J Blonsky |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609896596 PECOS PAC ID: 4880881861 Enrollment ID: I20140625000783 |
| Provider Name | Joseph Eble |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972766806 PECOS PAC ID: 9436205952 Enrollment ID: I20140701000804 |
| Provider Name | Kevin M Mcnamara |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1770744575 PECOS PAC ID: 9133344880 Enrollment ID: I20140714000786 |
| Provider Name | Bo Yon Choi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053551721 PECOS PAC ID: 5890920870 Enrollment ID: I20140828001949 |
| Provider Name | Andrew S Whitley |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1588096432 PECOS PAC ID: 9436377678 Enrollment ID: I20140829000144 |
| Provider Name | Madhulika Krish |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538168505 PECOS PAC ID: 5395722599 Enrollment ID: I20141013000321 |
| Provider Name | Haitham Elbhloul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619265337 PECOS PAC ID: 0941422471 Enrollment ID: I20141117000991 |
| Provider Name | Mary Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689077927 PECOS PAC ID: 5698097764 Enrollment ID: I20141126000634 |
| Provider Name | Timothy D Herrington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710321765 PECOS PAC ID: 9830412915 Enrollment ID: I20141222000615 |
| Provider Name | Katie Burden Greer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487948915 PECOS PAC ID: 3577790120 Enrollment ID: I20150109001824 |
| Provider Name | Caleb R Kendrix |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1659777423 PECOS PAC ID: 3678897709 Enrollment ID: I20150121000943 |
| Provider Name | Kathryn S Zackery |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356674782 PECOS PAC ID: 8224285887 Enrollment ID: I20150127001714 |
| Provider Name | Kathy Ridgway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508994138 PECOS PAC ID: 4284959321 Enrollment ID: I20150211001725 |
| Provider Name | Rebecca S Helms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841688702 PECOS PAC ID: 2961727029 Enrollment ID: I20150212000048 |
| Provider Name | Pavan Brar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992021802 PECOS PAC ID: 8022240092 Enrollment ID: I20150306001925 |
| Provider Name | Shawn Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578953394 PECOS PAC ID: 5092032532 Enrollment ID: I20150323001264 |
| Provider Name | Jennifer C Patchin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568866416 PECOS PAC ID: 5597083683 Enrollment ID: I20150422000672 |
| Provider Name | Terence J Vincent |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1508158312 PECOS PAC ID: 4486972486 Enrollment ID: I20150422001501 |
| Provider Name | Merry Huber |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1720499585 PECOS PAC ID: 2860710894 Enrollment ID: I20150423000246 |
| Provider Name | Matthew H Wiley |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1376830356 PECOS PAC ID: 0244476943 Enrollment ID: I20150519000854 |
| Provider Name | Kristen D Colbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891108593 PECOS PAC ID: 5092035485 Enrollment ID: I20150527000832 |
| Provider Name | Tanakorn Songrug |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1073847455 PECOS PAC ID: 7416184478 Enrollment ID: I20150604000595 |
| Provider Name | Tama R Dudley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326426602 PECOS PAC ID: 2466773833 Enrollment ID: I20150610002128 |
| Provider Name | Donald Von Borstel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275887663 PECOS PAC ID: 3779894860 Enrollment ID: I20150616001444 |
| Provider Name | Kyle G Flowers |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1063710580 PECOS PAC ID: 2769703107 Enrollment ID: I20150616001972 |
| Provider Name | Adam J Hoffhines |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1679891840 PECOS PAC ID: 7810111440 Enrollment ID: I20150622001931 |
| Provider Name | Marilyn Austin Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164819504 PECOS PAC ID: 1557672904 Enrollment ID: I20150625001972 |
| Provider Name | Jordan W Abbott |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750777348 PECOS PAC ID: 5991010647 Enrollment ID: I20150811003520 |
| Provider Name | Allison Nazinitsky |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922324011 PECOS PAC ID: 5092020313 Enrollment ID: I20150817000667 |
| Provider Name | Marcus Brown |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275776965 PECOS PAC ID: 8224250816 Enrollment ID: I20150901002419 |
| Provider Name | Kryston L Salsman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922498476 PECOS PAC ID: 3678880572 Enrollment ID: I20150909001941 |
| Provider Name | Dae Kim |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1003000597 PECOS PAC ID: 4082848189 Enrollment ID: I20150912000130 |
| Provider Name | Erica Kumar |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1265787758 PECOS PAC ID: 8921315235 Enrollment ID: I20150918002538 |
| Provider Name | Kevin Kierl |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992148407 PECOS PAC ID: 6103133640 Enrollment ID: I20150921000368 |
| Provider Name | Brandon J Hadel |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1427462050 PECOS PAC ID: 4385951342 Enrollment ID: I20150923002642 |
| Provider Name | Stephanie Shamburger |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1821464058 PECOS PAC ID: 0941519904 Enrollment ID: I20151014002454 |
| Provider Name | Mark A Gubichuk |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1487022026 PECOS PAC ID: 5193034908 Enrollment ID: I20151019000725 |
| Provider Name | Caitlin Schein |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1952539124 PECOS PAC ID: 7517199581 Enrollment ID: I20151104000387 |
| Provider Name | Christina Hulsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457625766 PECOS PAC ID: 8921264979 Enrollment ID: I20151204000303 |
| Provider Name | Akash Patel |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1871858548 PECOS PAC ID: 7618297441 Enrollment ID: I20151210000314 |
| Provider Name | Megan Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013283209 PECOS PAC ID: 4183856222 Enrollment ID: I20151210002266 |
| Provider Name | Amanda Sykora |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1871958108 PECOS PAC ID: 8820390685 Enrollment ID: I20160111001804 |
| Provider Name | Amber N Richardson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1962868588 PECOS PAC ID: 5991009532 Enrollment ID: I20160202002155 |
| Provider Name | Stacy Brooks |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1255733903 PECOS PAC ID: 0244536381 Enrollment ID: I20160316000140 |
| Provider Name | Laura J Adhikari |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1780848697 PECOS PAC ID: 9739235334 Enrollment ID: I20160324000588 |
| Provider Name | Ronald A Stillerman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679549166 PECOS PAC ID: 7214958370 Enrollment ID: I20160419000793 |
| Provider Name | Andrew J Lovell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902185077 PECOS PAC ID: 1951628619 Enrollment ID: I20160421002415 |
| Provider Name | Richard James Pearson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326484429 PECOS PAC ID: 4981993185 Enrollment ID: I20160511001017 |
| Provider Name | Sindhura Alapati |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528370319 PECOS PAC ID: 7012220189 Enrollment ID: I20160518001620 |
| Provider Name | Jayne Deanne Fortenberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679942585 PECOS PAC ID: 2365733763 Enrollment ID: I20160615000311 |
| Provider Name | Aaron Isley |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1427494921 PECOS PAC ID: 8729379029 Enrollment ID: I20160616000992 |
| Provider Name | Marsha Cobell-moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891990214 PECOS PAC ID: 8123319050 Enrollment ID: I20160623000182 |
| Provider Name | Angela D Shandy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043490329 PECOS PAC ID: 6103119722 Enrollment ID: I20160720000270 |
| Provider Name | Nigel Naman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184069080 PECOS PAC ID: 8921392333 Enrollment ID: I20160808002606 |
| Provider Name | George Polanco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326019332 PECOS PAC ID: 0244210755 Enrollment ID: I20160812001056 |
| Provider Name | Narendar K Jain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699871566 PECOS PAC ID: 3870523582 Enrollment ID: I20160825001975 |
| Provider Name | Tyler Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538514419 PECOS PAC ID: 6901192574 Enrollment ID: I20160907002416 |
| Provider Name | Jerad Ball |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790158764 PECOS PAC ID: 4183902299 Enrollment ID: I20161025000494 |
| Provider Name | Jamie Harris |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1942653530 PECOS PAC ID: 8022396852 Enrollment ID: I20161031000818 |
| Provider Name | Roselynn Dean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427445881 PECOS PAC ID: 4385938265 Enrollment ID: I20161104000531 |
| Provider Name | Amanda Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699127050 PECOS PAC ID: 0941588388 Enrollment ID: I20161105000069 |
| Provider Name | Julian T Vega |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467839621 PECOS PAC ID: 3476865676 Enrollment ID: I20170420001343 |
| Provider Name | Matthew Carmichael |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205147998 PECOS PAC ID: 0244495901 Enrollment ID: I20170420002548 |
| Provider Name | Roma A Patel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659637676 PECOS PAC ID: 4587897798 Enrollment ID: I20170518000179 |
| Provider Name | Alec M Watson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629455449 PECOS PAC ID: 1254610637 Enrollment ID: I20170523002160 |
| Provider Name | Emad Hamid |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457553588 PECOS PAC ID: 7618021999 Enrollment ID: I20170608002520 |
| Provider Name | Jeffrey Allen Coldwell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1518386903 PECOS PAC ID: 1052628484 Enrollment ID: I20170628003221 |
| Provider Name | Geoffrey Chow |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1447483565 PECOS PAC ID: 9234449141 Enrollment ID: I20170810002666 |
| Provider Name | Heather Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396107066 PECOS PAC ID: 8820360274 Enrollment ID: I20170818001832 |
| Provider Name | Chad Tyler Hollifield |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1215450671 PECOS PAC ID: 6305118423 Enrollment ID: I20170823003408 |
| Provider Name | Aatish M Patel |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1154611457 PECOS PAC ID: 6507098118 Enrollment ID: I20170905002638 |
| Provider Name | Ross L Forrester |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073040358 PECOS PAC ID: 6002180627 Enrollment ID: I20170920003999 |
| Provider Name | Brent L Roberts |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1114440138 PECOS PAC ID: 1850665282 Enrollment ID: I20170922001486 |
| Provider Name | John M Carlson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1740640291 PECOS PAC ID: 4486928868 Enrollment ID: I20170923000096 |
| Provider Name | Dustin P Renfro |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1760900955 PECOS PAC ID: 1658647169 Enrollment ID: I20171030000460 |
| Provider Name | Nathan T Wood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891781845 PECOS PAC ID: 3274890223 Enrollment ID: I20171129000596 |
| Provider Name | Teresa Hundley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174034003 PECOS PAC ID: 7618235805 Enrollment ID: I20171215002227 |
| Provider Name | Valoree Whiting |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427575877 PECOS PAC ID: 9032477237 Enrollment ID: I20171218000060 |
| Provider Name | Stephanie S Mcquarters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598284358 PECOS PAC ID: 0345294955 Enrollment ID: I20180116000408 |
| Provider Name | Angela Pinkston |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1205346814 PECOS PAC ID: 2668732272 Enrollment ID: I20180130001830 |
| Provider Name | Bea Jaye Warlick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730698739 PECOS PAC ID: 0143580662 Enrollment ID: I20180201001079 |
| Provider Name | Jacob Max Feldman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649634783 PECOS PAC ID: 6901186030 Enrollment ID: I20180213001144 |
| Provider Name | Victor M Tackett |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1518472281 PECOS PAC ID: 2163782178 Enrollment ID: I20180213002024 |
| Provider Name | Adam Boice Foster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811230311 PECOS PAC ID: 6406123504 Enrollment ID: I20180216001285 |
| Provider Name | Debra L Hudgins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457608192 PECOS PAC ID: 9133480700 Enrollment ID: I20180221002601 |
| Provider Name | Kevin L Hamm |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578657623 PECOS PAC ID: 8022919620 Enrollment ID: I20180223001203 |
| Provider Name | George Ghata |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487002556 PECOS PAC ID: 4183985633 Enrollment ID: I20180227000355 |
| Provider Name | Sheryl Angel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710497441 PECOS PAC ID: 5991066821 Enrollment ID: I20180309000973 |
| Provider Name | Tina Qualls |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710492558 PECOS PAC ID: 9638431430 Enrollment ID: I20180314001200 |
| Provider Name | Ashleigh C Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851669519 PECOS PAC ID: 9739441742 Enrollment ID: I20180402001225 |
| Provider Name | Breanna R Dale |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1033606330 PECOS PAC ID: 0547523755 Enrollment ID: I20180420000698 |
| Provider Name | Kathy L Alford Durbin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1700024114 PECOS PAC ID: 2365705498 Enrollment ID: I20180424000774 |
| Provider Name | Torie Fuller |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1053745646 PECOS PAC ID: 7719241421 Enrollment ID: I20180504001501 |
| Provider Name | Julia D Knarreborg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952662363 PECOS PAC ID: 3173828803 Enrollment ID: I20180613000456 |
| Provider Name | Charles Ronan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1639696057 PECOS PAC ID: 6608124003 Enrollment ID: I20180801001520 |
| Provider Name | Will Remington Goodrich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063953909 PECOS PAC ID: 5294083499 Enrollment ID: I20180803002060 |
| Provider Name | Andrew Phillips |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295256162 PECOS PAC ID: 8123377264 Enrollment ID: I20180822001681 |
| Provider Name | Kendra Woodson Muncrief |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861933939 PECOS PAC ID: 0547510331 Enrollment ID: I20180828003520 |
| Provider Name | Micah Wright |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295195824 PECOS PAC ID: 4082964366 Enrollment ID: I20180906003395 |
| Provider Name | Ashesh Bhakta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275984031 PECOS PAC ID: 5890046288 Enrollment ID: I20180925000403 |
| Provider Name | Ronald D Harrison |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1588778856 PECOS PAC ID: 6901196542 Enrollment ID: I20181003002144 |
| Provider Name | Misty D Sheldon |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1427063247 PECOS PAC ID: 7618268467 Enrollment ID: I20181008002552 |
| Provider Name | Brooke E Dillard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912487489 PECOS PAC ID: 2466704093 Enrollment ID: I20181010001199 |
| Provider Name | Kimberly Mcphearson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396196937 PECOS PAC ID: 9436401767 Enrollment ID: I20181015000773 |
| Provider Name | Nehal M Patel |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1306950688 PECOS PAC ID: 5597058156 Enrollment ID: I20181015002342 |
| Provider Name | Jamie R Cook |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1861506123 PECOS PAC ID: 1355631011 Enrollment ID: I20181016000250 |
| Provider Name | Roberto Reyes |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1265533178 PECOS PAC ID: 8921398405 Enrollment ID: I20181016002274 |
| Provider Name | Shilaja Kumar |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1336259373 PECOS PAC ID: 7315299567 Enrollment ID: I20181016003102 |
| Provider Name | Kathleen A Adolph |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1942220496 PECOS PAC ID: 3476843046 Enrollment ID: I20181016003155 |
| Provider Name | Michael T O'brien |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1629451067 PECOS PAC ID: 0446540157 Enrollment ID: I20181019000674 |
| Provider Name | Kate Gardner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801317631 PECOS PAC ID: 7810240801 Enrollment ID: I20181020000419 |
| Provider Name | Frederick M Christensen |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1487927570 PECOS PAC ID: 5597018572 Enrollment ID: I20181023002823 |
| Provider Name | Paul W Hamra |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598739591 PECOS PAC ID: 7517250186 Enrollment ID: I20181023003189 |
| Provider Name | Megan Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013419662 PECOS PAC ID: 6709130677 Enrollment ID: I20181112001735 |
| Provider Name | Melanie Laughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689154965 PECOS PAC ID: 6901140474 Enrollment ID: I20181211000488 |
| Provider Name | Lisa K Wright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831199124 PECOS PAC ID: 6406826668 Enrollment ID: I20181211002259 |
| Provider Name | Kyle F Summers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346663135 PECOS PAC ID: 6406119593 Enrollment ID: I20181211002393 |
| Provider Name | Jaron Marriott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396106837 PECOS PAC ID: 9931444320 Enrollment ID: I20181212002293 |
| Provider Name | Jonathan Daniel Bouldin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447735055 PECOS PAC ID: 7012252190 Enrollment ID: I20181218001495 |
| Provider Name | Linfan Jin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1902336175 PECOS PAC ID: 3678818408 Enrollment ID: I20181221001796 |
| Provider Name | David J Ingle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700884491 PECOS PAC ID: 4688561368 Enrollment ID: I20190103001997 |
| Provider Name | Kristin Corbin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780169631 PECOS PAC ID: 6204174741 Enrollment ID: I20190208000603 |
| Provider Name | Steven Matthew Wright |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366733404 PECOS PAC ID: 0042536575 Enrollment ID: I20190321000382 |
| Provider Name | Carol Ann Browning |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780864033 PECOS PAC ID: 4385705888 Enrollment ID: I20190506000410 |
| Provider Name | Tana Chongsuwat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184070963 PECOS PAC ID: 4385871987 Enrollment ID: I20190529001942 |
| Provider Name | Natosha Monfore |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1912343435 PECOS PAC ID: 6800129651 Enrollment ID: I20190610001765 |
| Provider Name | Kayla Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396237426 PECOS PAC ID: 3173857315 Enrollment ID: I20190622000049 |
| Provider Name | Tandaleo Gamble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578025078 PECOS PAC ID: 3173857281 Enrollment ID: I20190624002511 |
| Provider Name | Laresa D Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942755319 PECOS PAC ID: 8628302502 Enrollment ID: I20190626002513 |
| Provider Name | Michael J Walters |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1962768341 PECOS PAC ID: 6901198951 Enrollment ID: I20190709002215 |
| Provider Name | Gib Kirk Linzman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891211249 PECOS PAC ID: 6800121047 Enrollment ID: I20190711000082 |
| Provider Name | Zhamak Khorgami |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1902243470 PECOS PAC ID: 4284940628 Enrollment ID: I20190716003249 |
| Provider Name | Daniel J Dittus |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154770469 PECOS PAC ID: 1557644416 Enrollment ID: I20190726002182 |
| Provider Name | Brian Daniel Milman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417310947 PECOS PAC ID: 3779863782 Enrollment ID: I20190802001062 |
| Provider Name | Rachelle Haning |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528589363 PECOS PAC ID: 4284961806 Enrollment ID: I20190806000024 |
| Provider Name | Deena E Winham |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558913228 PECOS PAC ID: 2567799075 Enrollment ID: I20190806004017 |
| Provider Name | Eric Andrew Jensen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1306401583 PECOS PAC ID: 2668709916 Enrollment ID: I20190808002026 |
| Provider Name | Sarah Riopelle |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578981387 PECOS PAC ID: 8123374998 Enrollment ID: I20190822003328 |
| Provider Name | Meredith Hartman |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1710366984 PECOS PAC ID: 8921386012 Enrollment ID: I20190830000584 |
| Provider Name | Caroline Michele Markey |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255726360 PECOS PAC ID: 8527361062 Enrollment ID: I20190919000054 |
| Provider Name | Robert Bentley Lim |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518065614 PECOS PAC ID: 6002715752 Enrollment ID: I20190920001285 |
| Provider Name | Jennifer M Briggs |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215430251 PECOS PAC ID: 7416287248 Enrollment ID: I20190923000169 |
| Provider Name | Lauren Kilbury |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750802591 PECOS PAC ID: 2769712413 Enrollment ID: I20190924001694 |
| Provider Name | Tracy L Duckworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588136469 PECOS PAC ID: 6103156468 Enrollment ID: I20190930001180 |
| Provider Name | Katherine A Mosteller |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1255851523 PECOS PAC ID: 2567793516 Enrollment ID: I20191007001180 |
| Provider Name | Kimberly A Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245615129 PECOS PAC ID: 9739410218 Enrollment ID: I20191015000557 |
| Provider Name | Eugenio Erquiaga |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528005048 PECOS PAC ID: 6002947033 Enrollment ID: I20191016002639 |
| Provider Name | Aaron Beaver |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1982992947 PECOS PAC ID: 6204168859 Enrollment ID: I20191031000133 |
| Provider Name | Dj J Foster |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1245788330 PECOS PAC ID: 5395025316 Enrollment ID: I20191101001166 |
| Provider Name | Jamin P Brown |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649777095 PECOS PAC ID: 0941632699 Enrollment ID: I20191118002412 |
| Provider Name | Gary Clark Bundren Fennema |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578003992 PECOS PAC ID: 4981036522 Enrollment ID: I20191119003044 |
| Provider Name | Michelle Bates |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376047167 PECOS PAC ID: 5395178438 Enrollment ID: I20191204001451 |
| Provider Name | Johnathon K Lowe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962903963 PECOS PAC ID: 9133553787 Enrollment ID: I20200107002426 |
| Provider Name | Cheng-yen C Chen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386179968 PECOS PAC ID: 2769757996 Enrollment ID: I20200109001681 |
| Provider Name | Jubin Sadeghian |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265966980 PECOS PAC ID: 4880965284 Enrollment ID: I20200109002439 |
| Provider Name | Charles H Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306499603 PECOS PAC ID: 0446685887 Enrollment ID: I20200114000501 |
| Provider Name | Amanda L Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386137826 PECOS PAC ID: 3577812189 Enrollment ID: I20200212000467 |
| Provider Name | Frederick J Francis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073870382 PECOS PAC ID: 6901233642 Enrollment ID: I20200219001066 |
| Provider Name | Adrienne A Taren |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366976391 PECOS PAC ID: 3678844081 Enrollment ID: I20200220001031 |
| Provider Name | Monica Kidwell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1982636155 PECOS PAC ID: 0840620373 Enrollment ID: I20200423001196 |
| Provider Name | Gregory Bradley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881135804 PECOS PAC ID: 6608207824 Enrollment ID: I20200504000122 |
| Provider Name | Jay Scarborough |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952836520 PECOS PAC ID: 5799056792 Enrollment ID: I20200506000637 |
| Provider Name | Roy A Reed |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548764467 PECOS PAC ID: 1254762792 Enrollment ID: I20200515002078 |
| Provider Name | Christopher Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205321338 PECOS PAC ID: 9436570744 Enrollment ID: I20200521002482 |
| Provider Name | Nicholas A Strle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851703185 PECOS PAC ID: 4587999354 Enrollment ID: I20200527003392 |
| Provider Name | Cameron P Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831515287 PECOS PAC ID: 7214264449 Enrollment ID: I20200601000714 |
| Provider Name | Sarah E Lee |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538657119 PECOS PAC ID: 9638590177 Enrollment ID: I20200609000775 |
| Provider Name | Russell Brown |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1770003063 PECOS PAC ID: 1557783206 Enrollment ID: I20200625000830 |
| Provider Name | Nicole L Mcalester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699332031 PECOS PAC ID: 5395176051 Enrollment ID: I20200706002774 |
| Provider Name | Bassam Aldeeb |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376040758 PECOS PAC ID: 6507289535 Enrollment ID: I20200709002768 |
| Provider Name | Riley Shuler Polk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023506292 PECOS PAC ID: 4880018258 Enrollment ID: I20200717000805 |
| Provider Name | Matthew Sims |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982167813 PECOS PAC ID: 6204250376 Enrollment ID: I20200722001216 |
| Provider Name | Michael J Golden |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952527012 PECOS PAC ID: 9032353313 Enrollment ID: I20200727001331 |
| Provider Name | Samuel Wilson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083110514 PECOS PAC ID: 8729403423 Enrollment ID: I20200728003332 |
| Provider Name | Nabil A Yassa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467438911 PECOS PAC ID: 8729020839 Enrollment ID: I20200729000364 |
| Provider Name | Matthew B Millington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265939698 PECOS PAC ID: 7517382252 Enrollment ID: I20200729000914 |
| Provider Name | Shelby Wagner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972164200 PECOS PAC ID: 7315363090 Enrollment ID: I20200812000499 |
| Provider Name | Spenser H. Perloff |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861855272 PECOS PAC ID: 8628361904 Enrollment ID: I20200826001244 |
| Provider Name | Leslie A Kolmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750990867 PECOS PAC ID: 2062839608 Enrollment ID: I20200827003473 |
| Provider Name | Mckinley C Lawson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104137181 PECOS PAC ID: 6103056759 Enrollment ID: I20200902003088 |
| Provider Name | Morgan N Richards |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346603560 PECOS PAC ID: 6406149574 Enrollment ID: I20200915000924 |
| Provider Name | Emily Suku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922622869 PECOS PAC ID: 4789002221 Enrollment ID: I20200915001499 |
| Provider Name | Jeffrey J Wilson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1235757568 PECOS PAC ID: 5395163885 Enrollment ID: I20200915003003 |
| Provider Name | Whitney Potter |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1215314794 PECOS PAC ID: 4688904881 Enrollment ID: I20200918000338 |
| Provider Name | Susanna C Mcdaniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174131288 PECOS PAC ID: 1254750375 Enrollment ID: I20200923001042 |
| Provider Name | William T Rockwell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154881217 PECOS PAC ID: 3173942018 Enrollment ID: I20200928000579 |
| Provider Name | Jennifer Hastings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255958286 PECOS PAC ID: 4385063874 Enrollment ID: I20201002000250 |
| Provider Name | Jordan Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548821879 PECOS PAC ID: 2466871801 Enrollment ID: I20201002002518 |
| Provider Name | Levi D Duethman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821550161 PECOS PAC ID: 2769801158 Enrollment ID: I20201005001343 |
| Provider Name | Christian Bussey |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1578172284 PECOS PAC ID: 8224457064 Enrollment ID: I20201008000927 |
| Provider Name | Jeremiah M Daniel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316441652 PECOS PAC ID: 1052731155 Enrollment ID: I20201012000435 |
| Provider Name | Kimberly C Mai |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326609611 PECOS PAC ID: 7416377288 Enrollment ID: I20201015002829 |
| Provider Name | Joshua Baker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255892113 PECOS PAC ID: 0345660007 Enrollment ID: I20201019000929 |
| Provider Name | Elizabeth Richardson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275067902 PECOS PAC ID: 5294146650 Enrollment ID: I20201117000129 |
| Provider Name | Robin Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750901682 PECOS PAC ID: 8022114370 Enrollment ID: I20201222000479 |
| Provider Name | Cody A Due |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326536608 PECOS PAC ID: 5597178764 Enrollment ID: I20210107000458 |
| Provider Name | Laura M Janneck |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306160346 PECOS PAC ID: 6901064609 Enrollment ID: I20210120000806 |
| Provider Name | Bradley Roscoe Littleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912597204 PECOS PAC ID: 9931513009 Enrollment ID: I20210201001609 |
| Provider Name | Michael Nelson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1437344181 PECOS PAC ID: 6406944990 Enrollment ID: I20210204001689 |
| Provider Name | Jordyn Holbrook |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1821686858 PECOS PAC ID: 6608281365 Enrollment ID: I20210211000201 |
| Provider Name | George-thomas Pugh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942735360 PECOS PAC ID: 0244645745 Enrollment ID: I20210216000414 |
| Provider Name | Preston Pruett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942892146 PECOS PAC ID: 6406261684 Enrollment ID: I20210222000862 |
| Provider Name | Christopher D Roman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033266838 PECOS PAC ID: 1850482761 Enrollment ID: I20210302000860 |
| Provider Name | Julie Blizzard |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053774299 PECOS PAC ID: 4284040239 Enrollment ID: I20210317000813 |
| Provider Name | Mohd Qutob |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1679952584 PECOS PAC ID: 0244533842 Enrollment ID: I20210323002813 |
| Provider Name | Alex M. Riggs |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396308441 PECOS PAC ID: 2365852878 Enrollment ID: I20210325001302 |
| Provider Name | Ashley Mahaffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346825593 PECOS PAC ID: 9638587587 Enrollment ID: I20210414002421 |
| Provider Name | Kyle Hollmann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285195966 PECOS PAC ID: 7214336049 Enrollment ID: I20210528000143 |
| Provider Name | Andrew Hale |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1851786412 PECOS PAC ID: 6507266558 Enrollment ID: I20210611001628 |
| Provider Name | Judd W Miller |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1235628918 PECOS PAC ID: 8628478369 Enrollment ID: I20210616003142 |
| Provider Name | Jacqueline Tran Vo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255894028 PECOS PAC ID: 9032510854 Enrollment ID: I20210630000942 |
| Provider Name | Tyler Braaten |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1134507957 PECOS PAC ID: 3577964352 Enrollment ID: I20210630002842 |
| Provider Name | Rafel Alvarez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215383005 PECOS PAC ID: 7618247586 Enrollment ID: I20210630004007 |
| Provider Name | Matthew Bledsoe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295116721 PECOS PAC ID: 6608188024 Enrollment ID: I20210702002407 |
| Provider Name | Derek C Hill |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093323891 PECOS PAC ID: 9436552627 Enrollment ID: I20210726002607 |
| Provider Name | Jessica Stadler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427634500 PECOS PAC ID: 6305240573 Enrollment ID: I20210810002735 |
| Provider Name | Laura R Ballew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942877295 PECOS PAC ID: 6507261914 Enrollment ID: I20210824000942 |
| Provider Name | Brandon Koenigsknecht |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497218242 PECOS PAC ID: 5395141063 Enrollment ID: I20210903000524 |
| Provider Name | Nathan Nelson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639798150 PECOS PAC ID: 0345646964 Enrollment ID: I20210908000734 |
| Provider Name | Stephanie M Moses |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134796774 PECOS PAC ID: 0648674226 Enrollment ID: I20210909002821 |
| Provider Name | Jonathan Peaster |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467913368 PECOS PAC ID: 8123425089 Enrollment ID: I20210921001120 |
| Provider Name | James H Le |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447748959 PECOS PAC ID: 4385041862 Enrollment ID: I20210927000795 |
| Provider Name | Joshua Lowe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679059406 PECOS PAC ID: 1850728460 Enrollment ID: I20210927001578 |
| Provider Name | Gautami Gandham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639631690 PECOS PAC ID: 8224434410 Enrollment ID: I20210930000045 |
| Provider Name | Dillon Gillespie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548887029 PECOS PAC ID: 6406263839 Enrollment ID: I20211005002660 |
| Provider Name | Luke P Lewis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457915597 PECOS PAC ID: 7012313679 Enrollment ID: I20211028002948 |
| Provider Name | Taylor M Blose |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144859174 PECOS PAC ID: 4587052949 Enrollment ID: I20211104000457 |
| Provider Name | Edward Cho |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1336453406 PECOS PAC ID: 7214200104 Enrollment ID: I20211108000288 |
| Provider Name | Alexander B Hall |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487281986 PECOS PAC ID: 3375932338 Enrollment ID: I20211112000154 |
| Provider Name | Shelby Willis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730701251 PECOS PAC ID: 7012307366 Enrollment ID: I20211201001313 |
| Provider Name | Jarryd Horn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508493511 PECOS PAC ID: 9436553815 Enrollment ID: I20211202000665 |
| Provider Name | Heath Spencer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659900421 PECOS PAC ID: 4688064744 Enrollment ID: I20211203000207 |
| Provider Name | Jeff Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073933289 PECOS PAC ID: 2567899552 Enrollment ID: I20220111001859 |
| Provider Name | Jill D Holleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316181084 PECOS PAC ID: 9739239419 Enrollment ID: I20220214000896 |
| Provider Name | Nadeem El-kouri |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760002513 PECOS PAC ID: 1658765318 Enrollment ID: I20220223002820 |
| Provider Name | Michael Blose |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427687458 PECOS PAC ID: 3375937014 Enrollment ID: I20220224000752 |
| Provider Name | Amaya Basta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457589699 PECOS PAC ID: 0042434524 Enrollment ID: I20220324000345 |
| Provider Name | Dimple Shah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306023809 PECOS PAC ID: 5991952178 Enrollment ID: I20220329000431 |
| Provider Name | Sandeep Bhatia |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1003034927 PECOS PAC ID: 7719172162 Enrollment ID: I20220405001007 |
| Provider Name | Nicholas Busby |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1164097747 PECOS PAC ID: 1850796343 Enrollment ID: I20220419001120 |
| Provider Name | Harrison Daniel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245868991 PECOS PAC ID: 6103213186 Enrollment ID: I20220421000620 |
| Provider Name | John Burkart |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1275812745 PECOS PAC ID: 8022257435 Enrollment ID: I20220422001258 |
| Provider Name | Jeremiah Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992369037 PECOS PAC ID: 2264829068 Enrollment ID: I20220426001519 |
| Provider Name | Amanda Groden |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912407305 PECOS PAC ID: 6002213089 Enrollment ID: I20220426002217 |
| Provider Name | Tony Vanzant |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1326466459 PECOS PAC ID: 7618369414 Enrollment ID: I20220427000437 |
| Provider Name | Randal Riha |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588126684 PECOS PAC ID: 4486047248 Enrollment ID: I20220504000850 |
| Provider Name | Chance Dodson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093052664 PECOS PAC ID: 2264679364 Enrollment ID: I20220608000802 |
| Provider Name | Rachel Valcarcel |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1174271712 PECOS PAC ID: 4183003726 Enrollment ID: I20220701000365 |
| Provider Name | Ashley Scott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205325941 PECOS PAC ID: 4385049204 Enrollment ID: I20220707000400 |
| Provider Name | Seagal Dauglas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477016467 PECOS PAC ID: 9436539418 Enrollment ID: I20220708002724 |
| Provider Name | Jasmine Washington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811526510 PECOS PAC ID: 9638550353 Enrollment ID: I20220713000144 |
| Provider Name | Kiran Sibta Paul |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225591142 PECOS PAC ID: 7911388665 Enrollment ID: I20220713001168 |
| Provider Name | David Yoonsung Kim |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1760846125 PECOS PAC ID: 0446632038 Enrollment ID: I20220728002436 |
| Provider Name | Dustin W Cheney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225492606 PECOS PAC ID: 9133523418 Enrollment ID: I20220801002270 |
| Provider Name | Cyriece Jones |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154984995 PECOS PAC ID: 8224410659 Enrollment ID: I20220802002420 |
| Provider Name | Kendra Sherier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659834950 PECOS PAC ID: 8123400116 Enrollment ID: I20220818002639 |
| Provider Name | Emelia Potter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477139087 PECOS PAC ID: 3971987181 Enrollment ID: I20220907000107 |
| Provider Name | Andre Christensen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598083271 PECOS PAC ID: 4789989849 Enrollment ID: I20220923001277 |
| Provider Name | David C Remy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508131509 PECOS PAC ID: 3274562624 Enrollment ID: I20220927002820 |
| Provider Name | Marie L Duan Meservy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699018424 PECOS PAC ID: 0749588374 Enrollment ID: I20220927003400 |
| Provider Name | Daelor Osen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528644218 PECOS PAC ID: 5799151742 Enrollment ID: I20221017002961 |
| Provider Name | Daniel Kupsky |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346504206 PECOS PAC ID: 3577709690 Enrollment ID: I20221101000320 |
| Provider Name | Erin N Jorgensen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043579774 PECOS PAC ID: 5395033484 Enrollment ID: I20221121001573 |
| Provider Name | Carol Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093423030 PECOS PAC ID: 3678941580 Enrollment ID: I20221128001570 |
| Provider Name | Leslie Ann Jewett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619505732 PECOS PAC ID: 0345611851 Enrollment ID: I20230120000373 |
| Provider Name | Mark Borsody |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215179767 PECOS PAC ID: 5890844575 Enrollment ID: I20230123000220 |
| Provider Name | Jordan Nichole Dever |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508449430 PECOS PAC ID: 9537531256 Enrollment ID: I20230207000272 |
| Provider Name | Rylan Neal Russell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225614746 PECOS PAC ID: 1355727801 Enrollment ID: I20230208002729 |
| Provider Name | Caleb Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1376049858 PECOS PAC ID: 3779832233 Enrollment ID: I20230210001232 |
| Provider Name | Gloria Grim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942299276 PECOS PAC ID: 7911993340 Enrollment ID: I20230215001372 |
| Provider Name | Justin Sailo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295318152 PECOS PAC ID: 0749652964 Enrollment ID: I20230215002337 |
| Provider Name | Nathaniel Ng |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285217125 PECOS PAC ID: 9032581202 Enrollment ID: I20230216001000 |
| Provider Name | Hannah Shy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215510169 PECOS PAC ID: 6204209067 Enrollment ID: I20230227002451 |
| Provider Name | Codi Demere |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659959716 PECOS PAC ID: 2062885460 Enrollment ID: I20230306002698 |
| Provider Name | Dolly B Roy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053469072 PECOS PAC ID: 9436245891 Enrollment ID: I20230313000038 |
| Provider Name | Tanner Hessman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063090314 PECOS PAC ID: 1658745559 Enrollment ID: I20230315002861 |
| Provider Name | Dawn Demott |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912201641 PECOS PAC ID: 9739553389 Enrollment ID: I20230321002941 |
| Provider Name | Soumya Vempalle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134514896 PECOS PAC ID: 9032500392 Enrollment ID: I20230322000752 |
| Provider Name | Troy Clouse |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750373833 PECOS PAC ID: 5395750681 Enrollment ID: I20230327002917 |
| Provider Name | Kurtis Young |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992389597 PECOS PAC ID: 6608241690 Enrollment ID: I20230404002894 |
| Provider Name | Frank Hebroni |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437509494 PECOS PAC ID: 0941609754 Enrollment ID: I20230405000845 |
| Provider Name | Christopher Mcneil |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588242861 PECOS PAC ID: 7113397274 Enrollment ID: I20230405001527 |
| Provider Name | Patrick Sharp |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003494972 PECOS PAC ID: 8729451489 Enrollment ID: I20230413002426 |
| Provider Name | Alec Friesen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598345209 PECOS PAC ID: 5193181485 Enrollment ID: I20230524003822 |
| Provider Name | Scott Williams-gabriel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114636388 PECOS PAC ID: 7517330814 Enrollment ID: I20230531000010 |
| Provider Name | Colin Shawhan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1750787024 PECOS PAC ID: 8820455132 Enrollment ID: I20230620003260 |
| Provider Name | Joseph Carter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710566179 PECOS PAC ID: 3779941919 Enrollment ID: I20230624000376 |
| Provider Name | Cassie Stanzak |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1770737082 PECOS PAC ID: 8921467028 Enrollment ID: I20230708000517 |
| Provider Name | Natalia Solomon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003173915 PECOS PAC ID: 6709141328 Enrollment ID: I20230708000603 |
| Provider Name | Adam S Mednick |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1922015643 PECOS PAC ID: 8426140617 Enrollment ID: I20230711004659 |
| Provider Name | Brandon Postoak |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952979767 PECOS PAC ID: 9234599879 Enrollment ID: I20230714001166 |
| Provider Name | Joshua Miller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578144200 PECOS PAC ID: 6305206004 Enrollment ID: I20230721002304 |
| Provider Name | Anthony Diskin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1083282347 PECOS PAC ID: 3375903370 Enrollment ID: I20230724000549 |
| Provider Name | John Hiett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962022749 PECOS PAC ID: 4284095894 Enrollment ID: I20230802000253 |
| Provider Name | Savannah Phillips |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447989199 PECOS PAC ID: 9032571971 Enrollment ID: I20230809003346 |
| Provider Name | Usama Yassi |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1336482009 PECOS PAC ID: 0749411080 Enrollment ID: I20230816000394 |
| Provider Name | Jamie Nix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437814084 PECOS PAC ID: 9133511546 Enrollment ID: I20230816002479 |
| Provider Name | Hannah Nichols |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467982637 PECOS PAC ID: 4880002641 Enrollment ID: I20230825001978 |
| Provider Name | Lucas Massoth |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1770932949 PECOS PAC ID: 7012204845 Enrollment ID: I20230829004024 |
| Provider Name | Edgar Paul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578806659 PECOS PAC ID: 1355704719 Enrollment ID: I20230831004532 |
| Provider Name | Austin Marsh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346773850 PECOS PAC ID: 7911389002 Enrollment ID: I20230906003740 |
| Provider Name | Jessica Sumner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1487004941 PECOS PAC ID: 1153745039 Enrollment ID: I20230908001845 |
| Provider Name | Aaron Wittenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164486338 PECOS PAC ID: 0547298036 Enrollment ID: I20230911001825 |
| Provider Name | Konstantin Karmazin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326493313 PECOS PAC ID: 7113264680 Enrollment ID: I20230912001041 |
| Provider Name | Madison Puckett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902489073 PECOS PAC ID: 6002270451 Enrollment ID: I20230920002046 |
| Provider Name | Roman Edwards |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831763010 PECOS PAC ID: 0648634915 Enrollment ID: I20230922001556 |
| Provider Name | Charity Jones |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1164700241 PECOS PAC ID: 4486008521 Enrollment ID: I20230924000021 |
| Provider Name | Nathan Finch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144809641 PECOS PAC ID: 4981058781 Enrollment ID: I20230930000292 |
| Provider Name | Naila Paul |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1619974359 PECOS PAC ID: 8224419965 Enrollment ID: I20231001000067 |
| Provider Name | Ryan Acker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659949303 PECOS PAC ID: 4789039736 Enrollment ID: I20231011000085 |
| Provider Name | Robert Herman |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1750366514 PECOS PAC ID: 8921453846 Enrollment ID: I20231012003661 |
| Provider Name | Crystal Pelley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1851038244 PECOS PAC ID: 1052766961 Enrollment ID: I20231017002777 |
| Provider Name | Mattie N Lethermon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740063577 PECOS PAC ID: 0345696530 Enrollment ID: I20231024002967 |
| Provider Name | Ryan Winchell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720738628 PECOS PAC ID: 8820444128 Enrollment ID: I20231025003722 |
| Provider Name | Christopher Vietti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730892845 PECOS PAC ID: 8820444144 Enrollment ID: I20231028000579 |
| Provider Name | Jack Wade Lethermon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316722119 PECOS PAC ID: 9739535501 Enrollment ID: I20231031001416 |
| Provider Name | Ali A Taleb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134742869 PECOS PAC ID: 5496170698 Enrollment ID: I20231103001399 |
| Provider Name | Vincent Call |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699111245 PECOS PAC ID: 3274888730 Enrollment ID: I20231120001912 |
| Provider Name | Taylor Prado |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104490259 PECOS PAC ID: 4082062567 Enrollment ID: I20231122000016 |
| Provider Name | Stephen Burdick |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528246535 PECOS PAC ID: 2668882127 Enrollment ID: I20231127001170 |
| Provider Name | Stacey Kubovec |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245762673 PECOS PAC ID: 3779860440 Enrollment ID: I20231128001275 |
| Provider Name | Brianna Belden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952084428 PECOS PAC ID: 0446608111 Enrollment ID: I20231208000537 |
| Provider Name | Barrie Herring |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538516133 PECOS PAC ID: 8729437249 Enrollment ID: I20231219002638 |
| Provider Name | Hunter Wurtz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407425234 PECOS PAC ID: 8820448699 Enrollment ID: I20231220003418 |
| Provider Name | Mark Turner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770614968 PECOS PAC ID: 2264882737 Enrollment ID: I20231223000279 |
| Provider Name | Daniel Curtis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891026167 PECOS PAC ID: 5991155467 Enrollment ID: I20231223000379 |
| Provider Name | Janice Hicks Ulrich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114231701 PECOS PAC ID: 0042660516 Enrollment ID: I20231223000399 |
| Provider Name | Melisa Hodges |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265841712 PECOS PAC ID: 3779933247 Enrollment ID: I20231223000405 |
| Provider Name | Jamie Solie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427337419 PECOS PAC ID: 4688024151 Enrollment ID: I20231223000407 |
| Provider Name | April Pendley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427565670 PECOS PAC ID: 2961852439 Enrollment ID: I20231225000032 |
| Provider Name | Crystal Brill |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063540680 PECOS PAC ID: 3870943343 Enrollment ID: I20231225000048 |
| Provider Name | Crystal Downs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013225762 PECOS PAC ID: 1951751429 Enrollment ID: I20231225000074 |
| Provider Name | Melissa Ezell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225571805 PECOS PAC ID: 9638527781 Enrollment ID: I20231226000434 |
| Provider Name | Shaun Manning |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578086898 PECOS PAC ID: 4486004975 Enrollment ID: I20231226001081 |
| Provider Name | Robin Leblanc |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922326347 PECOS PAC ID: 2567812050 Enrollment ID: I20231226001387 |
| Provider Name | Terri Goughler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750768800 PECOS PAC ID: 6507216074 Enrollment ID: I20231227000088 |
| Provider Name | Mehyar Hefazi Torghabeh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548655343 PECOS PAC ID: 9830586767 Enrollment ID: I20231228001106 |
| Provider Name | Alice A Coe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497851034 PECOS PAC ID: 7315397882 Enrollment ID: I20231229000541 |
| Provider Name | Sang Ling Wu |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1235152034 PECOS PAC ID: 9739361007 Enrollment ID: I20240109000730 |
| Provider Name | Kerri S Remmel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639177884 PECOS PAC ID: 8921016908 Enrollment ID: I20240110005252 |
| Provider Name | Jennifer L Mathis-colley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548368988 PECOS PAC ID: 5890146070 Enrollment ID: I20240111004997 |
| Provider Name | Raymond Simms |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619927951 PECOS PAC ID: 1254789654 Enrollment ID: I20240118003712 |
| Provider Name | Ashwin Adivi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942950399 PECOS PAC ID: 0143673319 Enrollment ID: I20240125001647 |
| Provider Name | Safa Elsoueissi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881178416 PECOS PAC ID: 2860845831 Enrollment ID: I20240125002576 |
| Provider Name | Frank Jonathan Aughe-flores |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780334433 PECOS PAC ID: 5395192298 Enrollment ID: I20240129001578 |
| Provider Name | Arne Gratias |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144803305 PECOS PAC ID: 2264875871 Enrollment ID: I20240212001256 |
| Provider Name | Samuel Mcnulty |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407426299 PECOS PAC ID: 7315380789 Enrollment ID: I20240215003555 |
| Provider Name | Austin Gaby |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366192577 PECOS PAC ID: 3476997784 Enrollment ID: I20240216002010 |
| Provider Name | Kyle Sprangle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578128500 PECOS PAC ID: 3476902446 Enrollment ID: I20240301000143 |
| Provider Name | Danielle Morgan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780974691 PECOS PAC ID: 3476999715 Enrollment ID: I20240309000116 |
| Provider Name | Danielle Miller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528718434 PECOS PAC ID: 5698111599 Enrollment ID: I20240316000205 |
| Provider Name | Lisa Woodworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861968364 PECOS PAC ID: 1759623614 Enrollment ID: I20240316000259 |
| Provider Name | Brandon Walker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649912536 PECOS PAC ID: 4183060866 Enrollment ID: I20240316000411 |
| Provider Name | Itzel D Romo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790376473 PECOS PAC ID: 9234536988 Enrollment ID: I20240319001860 |
| Provider Name | Tabatha Maassen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871378497 PECOS PAC ID: 6507203635 Enrollment ID: I20240325001666 |
| Provider Name | Mariko Hanson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457840696 PECOS PAC ID: 1153686548 Enrollment ID: I20240401000777 |
| Provider Name | Warren Carrigan Iii |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326282153 PECOS PAC ID: 2466690847 Enrollment ID: I20240402001060 |
| Provider Name | Derek Martinez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881251387 PECOS PAC ID: 8426494519 Enrollment ID: I20240406000581 |
| Provider Name | Michael Haboubi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740410117 PECOS PAC ID: 1850535600 Enrollment ID: I20240427001869 |
| Provider Name | Trevor Barger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043599392 PECOS PAC ID: 9537501580 Enrollment ID: I20240522003950 |
| Mailing Address | Practice Location Address |
|---|---|
| Creek Nation Health System Dept 1038, Tulsa, OK 74182-0001 Ph: (918) 756-3334 | Creek Nation Health System 2900 N Main St, Muskogee, OK 74401-4078 Ph: (918) 346-7833 |