Lista Marie Dallis, - Medicare Nurse Practitioner in Tahlequah, OK

Lista Marie Dallis, is a medicare enrolled "Nurse Practitioner - Family" in Tahlequah, Oklahoma. She graduated from nursing school in 2019 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Northeastern Oklahoma Community Health Centers, Inc and her current practice location is 1500 E Downing St Ste 214, Tahlequah, Oklahoma. You can reach out to her office (for appointments etc.) via phone at (918) 413-0202.

Lista Marie Dallis is licensed to practice in Oklahoma (license number 99753) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1104468610.

Contact Information

Lista Marie Dallis,
1500 E Downing St Ste 214,
Tahlequah, OK 74464-3379
(918) 413-0202
(918) 431-0203



Provider's Profile

Full NameLista Marie Dallis
GenderFemale
SpecialityNurse Practitioner
Experience5 Years
Location1500 E Downing St Ste 214, Tahlequah, Oklahoma
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Lista Marie Dallis graduated from nursing school in 2019
  NPI Data:
  • NPI Number: 1104468610
  • Provider Enumeration Date: 10/16/2019
  • Last Update Date: 02/17/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 9032545595
  • Enrollment ID: I20200203000406

Medical Identifiers

Medical identifiers for Lista Marie Dallis such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1104468610NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family 99753 (Oklahoma)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Northeastern Health SystemTahlequah, OKHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Northeastern Oklahoma Community Health Centers, Inc367848263527

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Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lista Marie Dallis allows following entities to bill medicare on her behalf.
Entity NameNortheastern Oklahoma Community Health Centers, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1518070481
PECOS PAC ID: 3678482635
Enrollment ID: O20031104000417

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lista Marie Dallis is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Lista Marie Dallis,
Po Box 751,
Hulbert, OK 74441-0751

Ph: (187) 723-3990
Lista Marie Dallis,
1500 E Downing St Ste 214,
Tahlequah, OK 74464-3379

Ph: (918) 413-0202

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Nurse Practitioner Nurses in Tahlequah, OK

Nancy Ellen Denton, APRN-CNP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 401 E Downing St, Tahlequah, OK 74464
Phone: 918-316-6369    
Tina Marie Fort, APRN, NP-C
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1504 N Cedar Ave, Tahlequah, OK 74464
Phone: 918-456-3456    Fax: 855-860-5341
Kimberly Ann Watson, NP-C
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 19600 E Ross St, Tahlequah, OK 74464
Phone: 539-234-1000    
Libby Leininger Rogers, ARNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 529 N. Oak St, Tahlequah, OK 74464
Phone: 918-444-2126    Fax: 918-458-2300
Dena J Lamons, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464
Phone: 918-458-3100    
Tracy L Ross, APN
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 1387 W 4th St, Tahlequah, OK 74464
Phone: 918-453-5554    Fax: 918-431-4112
Florame Jamison, APRN
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 1373 E Boone St Ste 1201, Tahlequah, OK 74464
Phone: 918-207-1189    

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