MEDICARE: NIKI S LEWIS-WYATT PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	758	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922008572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKI S LEWIS-WYATT PAC

Provider Business Mailing Address
First Line	:	221 S GRAND AVE
Second Line	:
City	:	CHEROKEE
State	:	OK
Zip	:	73728-2029
Country	:	US
Telephone Number	:	580-307-6263
Fax Number	:	580-603-8602

Provider Business Practice Location Address
First Line	:	221 S GRAND AVE
Second Line	:
City	:	CHEROKEE
State	:	OK
Zip	:	73728-2029
Country	:	US
Telephone Number	:	580-307-6263
Fax Number	:	580-603-8602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/12/2025

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Directions to “ NIKI S LEWIS-WYATT PAC” Practice Location

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