Individual
TARA MIRANDA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
2510 CHICKASAW BLVD, ARDMORE, OK 73401-1341
(580) 226-8181
Mailing address
1925 WARRIOR WAY, ADA, OK 74820-3491
(580) 421-4570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1659
OK
Other
Enumeration date
11/05/2007
Last updated
07/10/2024
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