KEITH GERRELL PLUMMER PA-C
NPI 1932141728
Physician Assistant - Medical in Tishomingo, OK

Q: What is the provider's specialty?

The provider's specialty is Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.

Active since June 13, 2006PECOS Enrolled

610 E 24TH ST, TISHOMINGO, OK 73460(580) 371-2343(580) 371-2451 Get Directions Write a Review

NPPES record last updated: November 3, 2011. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Keith Gerrell Plummer Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEITH GERRELL PLUMMER PA-C (NPI 1932141728) is an individual medical provider in Tishomingo, Oklahoma, licensed in Oklahoma (794) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1932141728

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameKEITH GERRELL PLUMMERCredential: PA-C

Location Address610 E 24TH STTishomingo, OK 73460-3245

Mailing Address610 E 24th StTishomingo, OK 73460-3245 · (580) 371-2343 · Fax (580) 371-2451

Phone(580) 371-2343

Fax(580) 371-2451

Sole ProprietorNo

Enumeration DateJune 13, 2006

Last NPPES UpdateNovember 3, 2011

✔ NPI 1932141728 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in OK · 794

610 E 24TH ST, Tishomingo, OK 73460

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Other Identifiers 2

Medicare UPIN242319607OK

Medicaid100058030BOK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Oklahoma.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keith Gerrell Plummer Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TOMMIE GAY STANBERRY PA-C

Physician Assistant (Medical)