NPIMap

Organization Active NPI

Norman Psychiatry Aprn-CNP PLLC

  • Psychiatry Physician
  • Norman, OK
National Provider Identifier
1043728587
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
NORMAN PSYCHIATRY APRN-CNP PLLC
Practice address
2201 Westpark Dr
Norman, OK 73069-4012
Phone
(405) 579-1111
Fax
(405) 579-4223
NPI assigned
Jan 18, 2018
Reactivated
Jan 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

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

Authorized official

Name
Amber C Davis
Title
Office Manager
Phone
(405) 579-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2201 Westpark Dr
Norman, OK 73069-4012

Mailing address

2201 Westpark Dr
Norman, OK 73069-4012
Phone (405) 579-4111

Other practice location 1

1211 N Shartel Ave Ste 605
Oklahoma City, OK 73103-2425
Phone (405) 601-3999

Other identifiers 2

IdentifierTypeStateIssuer
200485210MedicaidOK
200768730MedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180416002406 OK Part B Supplier - Clinic/Group Practice 3971866484 Receives reassigned benefits from 11 practitioners
Practice locations: Norman, OK

National Provider Directory

National Provider Directory
Tax ID family
Christopher D Allen PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2201 Westpark Dr
Norman, OK 73069
Phone (405) 579-4111

1211 N Shartel Ave
Ste 605
Oklahoma City, OK 73103
Phone (405) 436-1506

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1043728587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 WESTPARK DR",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730694012",
            "telephone_number": "405-579-4111",
            "fax_number": "405-579-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 WESTPARK DR",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730694012",
            "telephone_number": "405-579-1111",
            "fax_number": "405-579-4223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 N Shartel Ave Ste 605",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731032425",
            "country_code": "US",
            "telephone_number": "405-601-3999",
            "fax_number": "405-601-4029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORMAN PSYCHIATRY APRN-CNP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "deactivation_date": "2019-10-17",
        "reactivation_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-579-4111"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200485210",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200768730",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.