Active NPI
Montana Perry
- Peer Specialist
- Wagoner, OK
National Provider Identifier
1154000925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1154000925
- Practice address
- 109 S Harrill Ave
Wagoner, OK 74467-5317 - Phone
- (918) 485-0204
- NPI assigned
- Jul 17, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Peer Specialist | 175T00000X | 1154000925 | OK | Primary |
Addresses
Primary practice location
109 S Harrill Ave
Wagoner, OK 74467-5317
Mailing address
109 S Harrill Ave
Wagoner, OK 74467-5317
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1154000925 | OK | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697673600000",
"number": "1154000925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 S HARRILL AVE",
"city": "WAGONER",
"state": "OK",
"postal_code": "744675317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 S HARRILL AVE",
"city": "WAGONER",
"state": "OK",
"postal_code": "744675317",
"telephone_number": "918-485-0204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "MONTANA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-17",
"last_updated": "2023-10-19",
"certification_date": "2023-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "1154000925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wagoner, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.