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

Mrs. Kelly Hacker, PA-C

Individual provider Physician Assistant · NPI 1104090208

Mrs. Kelly Hacker, PA-C is a Physician Assistant in Oklahoma City, Oklahoma. Qualified in 2003, 23 years ago. Practices with Integris Cardiovascular Physicians LLC, a 115-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
23
Licensed in
OK
In the registry since
2008
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

750 NE 13th St Ste 200
Oklahoma City, OK 73104-5051
Phone: (405) 627-1435
Fax: (405) 627-1869
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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 1373 (OK)

Record details

NPI number1104090208
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 18, 2008
Last updated in NPPESApril 18, 2008

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Integris Cardiovascular Physicians Llc — 115 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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