Individual provider Active NPI

Ashley Nicole Rogers-Edmonds

  • Mental Health Counselor
  • Pryor, OK
National Provider Identifier
1093288656
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
10949 Issued in OK
Practice address
109 N Fairland St
Pryor, OK 74361-4205
Phone
(918) 825-1405
NPI assigned
Jan 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Mental Health Counselor 101YM0800X 10949 OK Primary

Addresses

Primary practice location

109 N Fairland St
Pryor, OK 74361-4205

Mailing address

109 N Fairland St
Pryor, OK 74361-4205
Phone (918) 825-1405

Other names 1

  • Ashley Rogers Former name

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904003560 OK Practitioner - Mental Health Counselor 9830639996 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Lake Mental Health Center, Inc. 121 clinicians

Practice addresses (Care Compare)

231 E Graham Ave
Pryor, OK 74361-2436
Phone (918) 825-1405

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Lake Mental Health Center, Inc. CurrentSince Aug 21, 2024 Accepting new patients
Grand Lake Mental Health Center, Inc. CurrentSince Aug 21, 2024 Accepting new patients
Grand Lake Mental Health Center, Inc. Current Accepting new patients

Locations

111 S Treaty Rd
Miami, OK 74354
Phone (918) 540-1511

114 W Delaware Ave
Nowata, OK 74048
Phone 91827318412207

109 N Fairland St
Pryor, OK 74361
Phone (918) 825-1406

231 E Graham Ave
Pryor, OK 74361

405 E Excelsior Ave
Vinita, OK 74301
Phone (918) 256-6476

Organizations & group practices 3

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": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1093288656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N FAIRLAND ST",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614205",
            "telephone_number": "918-825-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N FAIRLAND ST",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614205",
            "telephone_number": "918-825-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS-EDMONDS",
        "first_name": "ASHLEY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-07",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "10949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "ROGERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pryor, OK

Sources for this page

Verify at the official NPI Registry.