Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Addison Roark, PA

Individual provider Physician Assistant · NPI 1225834922

Addison Roark, PA is a Physician Assistant in Tulsa, Oklahoma. Qualified in 2024, 2 years ago. Practices with Medwise LLC, a 33-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
2
Licensed in
OK
In the registry since
2025
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

12902 E 51st St Ste 3
Tulsa, OK 74134-6712
Phone: (918) 994-3482
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5471 (OK)

Record details

NPI number1225834922
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 22, 2025
Last updated in NPPESFebruary 22, 2025
Certification dateFebruary 22, 2025
Mailing address4209 N Redbud Pl, Broken Arrow, OK 74012-0453

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Medwise Llc — 33 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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