MR. THADDEUS DWAYNE MITCHAM (NPI# 1497120760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497120760 |
Entity Type | Individual |
Full Name | MR. THADDEUS DWAYNE MITCHAM |
Credential | PHYSICIAN ASSISTANT |
Practice Address |
7050 Air Depot Blvd Tinker Afb OK 73145-8716 |
Practice Telephone | 4055826231 |
Mailing Telephone | 4055826231 |
Enumeration Date | 2015-12-11 |
Last Update Date | 2018-04-19 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
7050 AIR DEPOT BLVD |
City | TINKER AFB |
State | OK |
Zip Code | 73145-8716 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902893084 | Michelle Marie Wueste | Pediatrics | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2005-10-04 |
1114486701 | James Neal Dillard IIi | Physician Assistant | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2019-03-14 |
1407313125 | Cindy Yie | Physician Assistant | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2019-02-28 |
1720501299 | William Moore | Student in an Organized Health Care Education/Training Program | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2017-07-17 |
1265954952 | Mark Gosnell Jr. | Military Health Care Provider | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2017-07-13 |
1245780170 | Mary Phillips | Social Worker | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2016-10-04 |
1528418175 | David Rodriguez | Family Medicine | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2016-06-14 |
1659755064 | Benjamin Winston | Dentist | 7050 Air Depot Blvd, Sgdd, Tinker Afb, OK 73145-8716 | 2015-07-15 |
1063895068 | Andrea Theye | Psychologist | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2015-07-08 |
1598148850 | Adrianna Harrell | Social Worker | 7050 Air Depot Blvd, Tinker Afb, OK 73145 | 2015-07-06 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922630946 | The Janz Corporation | Durable Medical Equipment & Medical Supplies | Tinker Afb Exchange, 3360 N. Avenue Bldg. 685, Tinker Afb, OK 73145 | 2020-02-07 |
1578863437 | Stephanie Brushett | Audiologist | 8941 Entrance Road A, Bldg 3334, Rm 125, Tinker Afb, OK 73145 | 2010-10-26 |
1972530053 | Mark Robert Bacon | Physician Assistant | 72nd Medical Group, 5700 Arnold St, Tinker Afb, OK 73145 | 2006-06-26 |
1417945346 | Heather Renee' Ranger Kobel | Psychologist | 590 Mitchell Blvd, Tinker Afb, OK 73145 | 2005-10-13 |
1003332404 | Davis Brigman | Psychologist | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2017-08-17 |
1801321393 | Carolyne Bangurah | Registered Nurse | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2017-04-21 |
1558748491 | Caitlin Clare Stevens | General Practice | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2015-04-29 |
1033498571 | Sarah Katherine Turbush | Dentist | 72d Medical Group, Tinker Afb, OK 73145 | 2011-08-16 |
1508000282 | Axelandra Tamar Sang | Military Health Care Provider | 5700 Arnold St, Bldg 5801, Tinker Afb, OK 73145 | 2009-04-27 |
1790936466 | William David Hinojosa | Surgery | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2008-09-30 |
Find all providers in zip 73145 |
Taxonomy Code | 363A00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407366453 | Luke Andrew Russell | Physician Assistant | 7050 Air Depot Blvd Bldg 1040, Tinker Afb, OK 73145-8716 | 2017-10-04 |
1568648681 | Rebecca G Prim | Physician Assistant | 7050 Air Depot, Bldg 1094, Tinker Afb, OK 73145-8102 | 2008-01-18 |
1114486701 | James Neal Dillard IIi | Physician Assistant | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2019-03-14 |
1407313125 | Cindy Yie | Physician Assistant | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2019-02-28 |
1477942951 | Jason Duren | Physician Assistant | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145-8716 | 2015-01-21 |
1811322852 | Joshua E Pearcy | Physician Assistant | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2013-09-10 |
1982923843 | Joseph Jones | Physician Assistant | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2010-05-18 |
1982679130 | Kristen Leigh Janssen | Physician Assistant | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145-8716 | 2006-02-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194326496 | Courtland Henderson | Physician Assistant | 2614 Wagon Trl, Enid, OK 73703-1630 | 2020-11-03 |
1013517168 | Madeleine Hill | Physician Assistant | 5304 N Hudson Ave, Oklahoma City, OK 73118-6232 | 2020-10-28 |
1851990097 | Lauren Heim | Physician Assistant | 7324 Bucks Xing, Edmond, OK 73034-3520 | 2020-10-19 |
1003414673 | Stephanie Ann Stephens | Physician Assistant | 5021 Eric Dr, Oklahoma City, OK 73135-4129 | 2020-10-15 |
1508464355 | Lauren Danielle Ukleya | Physician Assistant | 1315 Chisholm Trail Pkwy Ste A, Duncan, OK 73533-1544 | 2020-10-14 |
1598362964 | Madison Kitchens | Physician Assistant | 471688 Ok-51, Stilwell, OK 74960 | 2020-10-07 |
1689271041 | Maissa Baker Mitwalli | Physician Assistant | 700 S Desert Palm Ave, Broken Arrow, OK 74012-8815 | 2020-10-07 |
1730705229 | Jenna Specht | Physician Assistant | 2501 N 14th St, Ponca City, OK 74601-1734 | 2020-06-19 |
1477176147 | April Dawn Sullivan | Physician Assistant | 1111 Walnut Dr, Ardmore, OK 73401-2354 | 2020-05-28 |
1497384754 | Leah Cannady Hester | Physician Assistant | 3145 Midland Valley St, Norman, OK 73069-6970 | 2020-04-07 |
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City | TINKER AFB |
Zip Code | 73145 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.