Individual provider Active NPI

Rebecca Young, RN

  • Primary Care Nurse Practitioner
  • Broken Arrow, OK
National Provider Identifier
1154789576
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
96847 Issued in OK
Practice address
7801 S Oak PL
Broken Arrow, OK 74011
Phone
(918) 406-7264
NPI assigned
Jan 29, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 96847 OK
Primary Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP2300X 96847 OK Primary

Addresses

Primary practice location

7801 S Oak PL
Broken Arrow, OK 74011

Mailing address

7801 S Oak PL
Broken Arrow, OK 74011-6230
Phone (918) 406-7264

Other practice location 1

17110 E 51st St
Broken Arrow, OK 74012-9279
Phone (918) 355-1596

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191108002354 OK Order and Referring Only - Nurse Practitioner 8628400850

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
96847OKMDPrimary Care Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1154789576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7801 S OAK PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740116230",
            "telephone_number": "918-406-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 S OAK PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74011",
            "telephone_number": "918-406-7264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17110 E 51st St",
            "address_purpose": "LOCATION",
            "city": "Broken Arrow",
            "state": "OK",
            "postal_code": "740129279",
            "country_code": "US",
            "telephone_number": "918-355-1596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-29",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "96847",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OK",
            "license": "96847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.