Carol Lynn Black, APRN-CNP
Individual provider Active NPI Family Nurse Practitioner · Coalgate, OK
NPI 1013427129 · NPPES record last updated Dec 19, 2022
Key facts
- NPI
- 1013427129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R0067047 (OK)
- Practice address
- 107 E Post Ave
Coalgate, OK 74538-3004 - Phone
- (580) 927-2828
- Fax
- (580) 927-9876
- NPI assigned
- Oct 3, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Health Center of Southern Oklahoma Inc
Practice addresses (Care Compare)
610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 387-0509
Hospital & facility affiliations
- Mays Housecall Home Health of Durant
- Always Better Care Home Health
- A Path of Care Tendercare Home Health
- Choice Health at Home - Antlers
- Mercy Hospital Ada
- Coal County General Hospital, Inc.
- Mercy Hospital Ardmore, Inc
- O U Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171122000573 | OK | Practitioner - Nurse Practitioner | 3971860214 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0067047 | OK | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Center of Southern Oklahoma Inc | Current |
Accepting new patients | |
| Family Health Center of Southern Oklahoma Inc | Current |
Accepting new patients | |
| Family Health Center of Southern Oklahoma Inc | Current | Accepting new patients |
Locations
107 E Post Ave
Coalgate, OK 74538
Phone (580) 927-2828
610 E 24th St
Tishomingo, OK 73460
Phone (580) 371-2343
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73380
- carol.maxwell@fhcso.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 67047 | OK | |
| Family Nurse Practitioner | 363LF0000X | R0067047 | OK | Yes |
Addresses
Primary practice location
107 E Post Ave
Coalgate, OK 74538-3004
Mailing address
610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 371-2343
Other providers in Coalgate, OK
- A Path of Care Home Health IV, LLC
- Quinton Ty Bohannon
- Joy Burris
- Matt Calvert
- City of Coalgate
- Coal County Extended Care Incorporated
All providers in Coalgate, OK · Family Nurse Practitioner in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.