NPIMap

Individual provider Active NPI

Carol Lynn Black, APRN-CNP

  • Family Nurse Practitioner
  • Coalgate, OK
National Provider Identifier
1013427129
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0067047 Issued in OK
Practice address
107 E Post Ave
Coalgate, OK 74538-3004
Phone
(580) 927-2828
Fax
(580) 927-9876
NPI assigned
Oct 3, 2017
Last updated
Dec 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 67047 OK
Family Nurse Practitioner 363LF0000X R0067047 OK Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171122000573 OK Practitioner - Nurse Practitioner 3971860214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 387-0509

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
67047OKMDFamily Nurse Practitioner
R0067047OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Center of Southern Oklahoma Inc CurrentSince Oct 10, 2017 Accepting new patients
Family Health Center of Southern Oklahoma Inc Current Accepting new patients
Family Health Center of Southern Oklahoma Inc CurrentSince Oct 10, 2017 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

  • Direct secure messaging: carol.maxwell@fhcso.directbygreenway.com
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73380

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1013427129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 E 24TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603245",
            "telephone_number": "580-371-2343",
            "fax_number": "580-371-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E POST AVE",
            "city": "COALGATE",
            "state": "OK",
            "postal_code": "745383004",
            "telephone_number": "580-927-2828",
            "fax_number": "580-927-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CAROL",
        "middle_name": "LYNN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-03",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "67047",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0067047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coalgate, OK

Sources for this page

Verify at the official NPI Registry.