Active NPI
Andrea Michelle Blank, LCSW
- Clinical Social Worker
- Edmond, OK
National Provider Identifier
1114924628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2265
- Practice address
- 501 E 15TH St
Suite 500a
Edmond, OK 73013-5043 - Phone
- (405) 888-5299
- Fax
- (405) 888-5322
- NPI assigned
- Jun 30, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2265 | OK | Primary |
Addresses
Primary practice location
501 E 15TH St
Suite 500a
Edmond, OK 73013-5043
Mailing address
15951 Little Axe Dr
Norman, OK 73026-9088
Phone (405) 447-0300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2265 | OK | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omh Home Health | Past | Accepting new patients | |
| Okmulgee Memorial Hospital, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Okmulgee, OK
- NPI 1083616221
-
- Home Health Agency
- Okmulgee, OK
- NPI 1831191543
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527206400000",
"number": "1114924628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15951 LITTLE AXE DR",
"city": "NORMAN",
"state": "OK",
"postal_code": "730269088",
"telephone_number": "405-447-0300",
"fax_number": "405-701-7914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 E 15TH ST",
"address_2": "SUITE 500A",
"city": "EDMOND",
"state": "OK",
"postal_code": "730135043",
"telephone_number": "405-888-5299",
"fax_number": "405-888-5322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANK",
"first_name": "ANDREA",
"middle_name": "MICHELLE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-30",
"last_updated": "2018-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "2265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.