Michelle Renee Sturdivant, NP
Individual provider Active NPI Adult Health Nurse Practitioner · Moore, OK
NPI 1154873743 · NPPES record last updated Dec 26, 2024
Key facts
- NPI
- 1154873743
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- R0100094 (OK)
- Practice address
- 616 SW 6TH St
Moore, OK 73160-2511 - Phone
- (405) 595-6969
- NPI assigned
- Oct 29, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 15
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Carnegie Tri-County Municipal Hospital Management Inc
Seiling Municipal Hospital Authority
Cah Acquisition Company 9 LLC
Practice addresses (Care Compare)
102 N Broadway
Carnegie, OK 73015-0097
Phone (580) 654-1050
809 NE Hwy 60
Specialty Clinic
Seiling, OK 73663-2705
Phone (580) 377-1005
PO Box
Suite 720
Seiling, OK 73663
Hospital & facility affiliations
- Carnegie Tri-County Municipal Hospital
- Seiling Municipal Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170209000208 | OK | Practitioner - Nurse Practitioner | 4183907579 | Reassigns benefits to 9 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0100094 | OK | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ies Oklahoma LLC | Current |
Accepting new patients | |
| Seiling Municipal Hospital Authority | Current | Accepting new patients | |
| Mangum City Hospital Authority | Current |
Accepting new patients | |
| Mangum City Hospital Authority | Current |
Accepting new patients | |
| Prague Healthcare Authority | Current |
Accepting new patients | |
| Prague Healthcare Authority | Current |
Accepting new patients | |
| Carnegie Tri-County Municipal Hospital Management, Inc. | Current |
Accepting new patients | |
| Seiling Municipal Hospital Authority | Current |
Accepting new patients | |
| Seiling Municipal Hospital Authority | Current |
Accepting new patients | |
| Carnegie Tri-County Municipal Hospital Management, Inc | Current |
Accepting new patients | |
| Carnegie Tri-County Municipal Hospital Management, Inc. | Current | Accepting new patients | |
| Legacy Chiropractic Inc. | Past |
Accepting new patients | |
| Cah Acquisition Company 9, LLC | Past | Accepting new patients |
Locations
101 W Ash St
Carnegie, OK 73015
Phone (580) 654-1154
102 N Broadway St
Carnegie, OK 73015
Phone (580) 654-1050
1401 W Pawnee St
Cleveland, OK 74020
Phone (918) 358-2501
5602 SW Lee Blvd
Lawton, OK 73505
Phone (580) 531-4700
118 S Louis Tittle Ave
Mangum, OK 73554
Phone (580) 782-2000
1 Wickersham St
Mangum, OK 73554
Phone (580) 782-3353
1101 E 15th St
Pawhuska, OK 74056
Phone (918) 287-3232
1109 E 15th St
Pawhuska, OK 74056
Phone (918) 287-3232
1322 Klabzuba Ave
Prague, OK 74864
Phone (405) 567-2295
809 NE Highway 60
Seiling, OK 73663
Phone (580) 377-1005
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/carntri-0870329c
- https://fhir-usa.unify.chbase.com/org/pawhusk-5551a701
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | R0100094 | OK | Yes |
Addresses
Primary practice location
616 SW 6TH St
Moore, OK 73160-2511
Mailing address
616 SW 6TH St
Moore, OK 73160-2511
Phone (405) 595-6969
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200791020A | Medicaid | OK | |
| R0100094 | Other | OK | LICENSE |
Other providers in Moore, OK
- Courtney Strain
- Tonya Kay Stringer
- Teeia Strout
- Haley Harrison Strutton
- Nicole Stull
- Kylee Sullivan
- Summer Dental Moore PLLC
- Sunrise Pediatrics PLLC
- Tonya Lynn Sutherby
- Heesook Sutter
All providers in Moore, OK · Adult Health Nurse Practitioner in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.