IndividualActive
Raegan Dewilde
NPI 1780226084 · Medical Physician Assistant · Fairview, OK
Provider details
- NPI number
- 1780226084
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Student, Health Care
Practice location
523 E State Rd
Fairview, OK 73737-1453
Phone: (580) 227-2585
Approximate (ZIP-level) locationGet directions
Mailing address
716 S Hickory St
Sapulpa, OK 74066-5130
Registry dates
- Enumerated
- 2019-10-08
- Last updated
- 2022-06-08
- Certified
- 2022-06-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.