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

Lista Marie Dallis

Individual provider Family Nurse Practitioner · NPI 1104468610

Lista Marie Dallis is a Nurse Practitioner in Tahlequah, Oklahoma. Qualified in 2019, 7 years ago. Practices with Northeastern Oklahoma Community Health Centers, Inc, a 36-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
7
Licensed in
OK
In the registry since
2019
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Practice location Address checks out

1500 E Downing St Ste 214
Tahlequah, OK 74464-3379
Phone: (918) 413-0202
Fax: (918) 431-0203
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 99753 (OK)

Record details

NPI number1104468610
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 16, 2019
Last updated in NPPESFebruary 17, 2022
Certification dateFebruary 17, 2022
Mailing addressPo Box 751, Hulbert, OK 74441-0751

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Northeastern Oklahoma Community Health Centers, Inc — 36 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Tahlequah