Individual provider Active NPI

Mary Fazio, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1093163248
Registry record updated Feb 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
82870 Issued in OK
Practice address
4913 W Reno Ave
Oklahoma City, OK 73127-6339
Phone
(405) 948-4900
NPI assigned
May 28, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2019

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 82870 OK Primary

Addresses

Primary practice location

4913 W Reno Ave
Oklahoma City, OK 73127-6339

Mailing address

2908 NW 19TH St
Oklahoma City, OK 73107-3911
Phone (405) 250-6080

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
I20180625001235 OK Practitioner - Nurse Practitioner 6507111051 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3300 NW Expressway
Oklahoma City, OK 73112-4418
Phone (405) 949-3141

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
82870OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation CurrentSince Jul 30, 2025 Accepting new patients

Locations

3300 NW Expressway St
Oklahoma City, OK 73112
Phone (405) 251-2815

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

3001 Quail Springs Pkwy
Fl 5
Oklahoma City, OK 73134

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.

Hospital & facility affiliations 4

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": "1464393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549238400000",
    "number": "1093163248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 NW 19TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731073911",
            "telephone_number": "405-250-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZIO",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "DNP, APRN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-28",
        "last_updated": "2019-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "82870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.