NPIMap

Organization Active NPI

Main Street Family Healthcare Nurse Practitioner Clinic, LLC

  • Primary Care Clinic/Center
  • Stroud, OK
National Provider Identifier
1154719169
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
R0052024 Issued in OK
Legal business name
MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC, LLC
Practice address
309 W Main St
Stroud, OK 74079-3611
Phone
(918) 987-0067
NPI assigned
Dec 27, 2014
Last updated
Dec 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

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

Authorized official

Name
Bronwyn L. Howard, APRN-CNPNPI 1619161205
Title
Owner/Operator
Phone
(918) 950-5053

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X R0052024 OK Primary

Addresses

Primary practice location

309 W Main St
Stroud, OK 74079-3611

Mailing address

309 W Main St
P.O. Box 968
Stroud, OK 74079-3611
Phone (918) 987-0067

Other identifiers 2

IdentifierTypeStateIssuer
200121770AMedicaidOK
2005513360AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1419638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1154719169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 W MAIN ST",
            "address_2": "P.O. BOX 968",
            "city": "STROUD",
            "state": "OK",
            "postal_code": "740793611",
            "telephone_number": "918-987-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 W MAIN ST",
            "city": "STROUD",
            "state": "OK",
            "postal_code": "740793611",
            "telephone_number": "918-987-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-27",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "BRONWYN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "918-950-5053",
        "authorized_official_credential": "APRN-CNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "R0052024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200121770A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2005513360A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stroud, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.