Mary Chance
Individual provider Active NPI Family Nurse Practitioner · Kingfisher, OK
NPI 1083190896 · NPPES record last updated Jul 15, 2018
Key facts
- NPI
- 1083190896
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 105718 (OK)
- Practice address
- 1100 Hospital Cir
Kingfisher, OK 73750-5001 - Phone
- (405) 375-2350
- NPI assigned
- Jul 15, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
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 |
|---|---|---|---|---|
| I20180905002860 | OK | Practitioner - Nurse Practitioner | 3072863455 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105718 | OK | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kingfisher Clinic PLLC | Current |
Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients |
Locations
1100 Hospital Cir
Kingfisher, OK 73750
Phone (405) 375-2350
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/e0aed929-e53b-4d96-a40c-36cb9539f12f/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 105718 | OK | |
| Family Nurse Practitioner | 363LF0000X | 105718 | OK | Yes |
Addresses
Primary practice location
1100 Hospital Cir
Kingfisher, OK 73750-5001
Mailing address
1100 Hospital Cir
Kingfisher, OK 73750-5001
Other providers in Kingfisher, OK
- Melody C Byrd
- Kristyn Cagle
- Cardiac and Pulmonary Rehabilitation Clinic LLC
- Diane Castellanos
- Amy R Cavner
- Chisholm Medical Equipment
- City of Kingfisher
- Compassion Clinic Pharmacy
- Jimmy Lee Couch
- Countrywood Assisted Living & Memory Care, LLC
All providers in Kingfisher, 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 Jul 15, 2018. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.