OrganizationActive
Lakeside Family Medicine
NPI 1295064178 · Family Medicine Physician · Kingston, OK
Provider details
- NPI number
- 1295064178
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Pamela Ahearn, Owner/President(580) 226-1010
- License
- 19862 (OK)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
21 N. Main Street
Kingston, OK 73439-1798
Phone: (580) 226-1010
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 1798
Kingston, OK 73439-1798
Registry dates
- Enumerated
- 2009-12-23
- Last updated
- 2009-12-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.