Individual provider Active NPI

Caroline Anne Whitaker, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Moore, OK
National Provider Identifier
1073201414
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
212466 Issued in OK
Practice address
1105 SW 30TH CT
Moore, OK 73160-2887
Phone
(405) 378-4439
NPI assigned
Apr 25, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 212466 OK Primary

Addresses

Primary practice location

1105 SW 30TH CT
Moore, OK 73160-2887

Mailing address

10801 Quail Cir
Oklahoma City, OK 73120-2442
Phone (918) 916-9924

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
I20240321003719 OK Practitioner - Nurse Practitioner 1052758331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Saint Louis University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Balance Womens Health LLCGroup PAC ID 3476927740, 89 clinicians

Practice addresses (Care Compare)

1105 SW 30TH CT
Moore, OK 73160-2887
Phone (405) 378-2727

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Balance Women'S Health, LLC CurrentSince Feb 1, 2024 Accepting new patients

Locations

1105 SW 30th Ct
Moore, OK 73160
Phone (405) 378-4439

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.carolinewhitaker@148561.advancedmd-direct.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1682380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1073201414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 QUAIL CIR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731202442",
            "telephone_number": "918-916-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SW 30TH CT",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602887",
            "telephone_number": "405-378-4439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "CAROLINE",
        "middle_name": "ANNE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-25",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OK",
            "license": "212466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.