NPIMap

Individual provider Active NPI

Nichole Marie Blackburn, FNP-C

  • Family Nurse Practitioner
  • Elk City, OK
National Provider Identifier
1154027829
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
211675 Issued in OK
Practice address
522 N Main St
Elk City, OK 73644-4241
Phone
(580) 243-2200
Fax
(580) 303-4712
NPI assigned
Feb 3, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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 211675 OK Primary

Addresses

Primary practice location

522 N Main St
Elk City, OK 73644-4241

Mailing address

11000 Hefner Pointe Dr
Oklahoma City, OK 73120-5039
Phone (405) 749-9655

Other practice location 1

1315 N Washington St
Weatherford, OK 73096-2443
Phone (580) 772-2344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230920003672 OK Practitioner - Nurse Practitioner 0244684587 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Urology Associates, Inc.Group PAC ID 5395763064, 14 clinicians

Practice addresses (Care Compare)

11000 Hefner Pointe Dr
Oklahoma City, OK 73120-5039
Phone (405) 749-9655

Hospital & facility affiliations

  • Great Plains Regional Medical Center Hospital, Elk City, OK, CCN 370019
  • Jackson County Memorial Hospital Authority Hospital, Altus, OK, CCN 370022
  • Weatherford Regional Hospital, Inc of Weatherford Hospital, Weatherford, OK, CCN 371323
  • Elkview General Hospital Hospital, Hobart, OK, CCN 370783
  • Cordell Memorial Hospital Hospital, Cordell, OK, CCN 371325

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bluth Family Medicine, LLC CurrentSince Jul 10, 2023 Accepting new patients
Jackson County Memorial Hospital Authority Current Accepting new patients
Diabetic Centers for Excellence LLC CurrentSince Oct 21, 2023 Accepting new patients
Urology Associates, Inc. CurrentSince Mar 3, 2025 Accepting new patients
Weatherford Hospital Authority Past Accepting new patients

Locations

522 N Main St
Elk City, OK 73644
Phone (580) 243-2200

11000 Hefner Pointe Dr
Oklahoma City, OK 73120
Phone (405) 749-9655

8640 S Peoria Ave
Tulsa, OK 74132
Phone (310) 804-1231

1315 N Washington St
Weatherford, OK 73096
Phone (580) 248-8481

Interoperability endpoints

  • Direct secure messaging: him@direct.jcmh.com
  • FHIR API: https://app.meldrx.com/api/fhir/uc27885_uroassocincok
  • FHIR API: https://fhir4.healow.com/fhir/r4/EDEECD
  • FHIR API: https://drchrono-fhirpresentation.everhealthsoftware.com/fhir/drchrono/493729/r4

Organizations & group practices 5

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 10

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": "1675382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1154027829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 HEFNER POINTE DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205039",
            "telephone_number": "405-749-9655",
            "fax_number": "405-749-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 N MAIN ST",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736444241",
            "telephone_number": "580-243-2200",
            "fax_number": "580-303-4712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1315 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Weatherford",
            "state": "OK",
            "postal_code": "730962443",
            "country_code": "US",
            "telephone_number": "580-772-2344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "NICHOLE",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-03",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "211675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk City, OK

Sources for this page

Verify at the official NPI Registry.