Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 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

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

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients62
Services billed 203 a service is one billed item, such as a visit, a test or a procedure
Average patient age70

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Northeastern Oklahoma Community Health Centers, Inc

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 36 clinicians in the practice; 12 are shown here.

Other providers in Tahlequah