Individual provider Active NPI

Julie Shaffer, APRN, FNP-C

  • Family Nurse Practitioner
  • Owasso, OK
National Provider Identifier
1053080036
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
204871 Issued in OK
Practice address
11426 N 134TH East Ave
Owasso, OK 74055-4715
Phone
(918) 727-2273
NPI assigned
Sep 13, 2021
Last updated
Sep 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 204871 OK Primary

Addresses

Primary practice location

11426 N 134TH East Ave
Owasso, OK 74055-4715

Mailing address

10757 E 350 Rd
Talala, OK 74080-9689
Phone (918) 688-2823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220128000112 OK Practitioner - Nurse Practitioner 5890187645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
On Demand Urgent Care, LLCGroup PAC ID 9234565110, 6 clinicians

Practice addresses (Care Compare)

11426 N 134TH E Ave
Owasso, OK 74055-4715
Phone (918) 727-2273

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
204871OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
On Demand Urgent Care, LLC CurrentSince Nov 1, 2021 Accepting new patients

Locations

11426 N 134th East Ave
Owasso, OK 74055
Phone (918) 376-6345

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1053080036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10757 E 350 RD",
            "city": "TALALA",
            "state": "OK",
            "postal_code": "740809689",
            "telephone_number": "918-688-2823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11426 N 134TH EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740554715",
            "telephone_number": "918-727-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "JULIE",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "204871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owasso, OK

Sources for this page

Verify at the official NPI Registry.