Angela Diane Miller Mack

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

2 Miles East of Boley on Hwy 62
Boley, OK 74829

Phone

(918) 667-3367

Fax

(918) 667-3367

NPI assigned

Sep 20, 2023

Last updated

Sep 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stepping Stones, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boley, OK
  • NPI 1508865841
  NPD (past)
• Stepping Stones, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boley, OK
  • NPI 1649360025
  NPD (past)

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1205614161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "BOLEY",
            "state": "OK",
            "postal_code": "748290218",
            "telephone_number": "918-667-3367",
            "fax_number": "918-667-3367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MILES EAST OF BOLEY ON HWY 62",
            "city": "BOLEY",
            "state": "OK",
            "postal_code": "74829",
            "telephone_number": "918-667-3367",
            "fax_number": "918-667-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER MACK",
        "first_name": "ANGELA",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100685600D",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006856600A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Mark Keltner
• Marilyn Elizabeth Kincade, LPC, NCC
• Jonathan Paul Looney
• Donna Danelle Magness, MS, LPC CANDIDATE
• Zondra Magness
• Brian David Moore, BA, BHRS
• Lisa Moore
• Tami Morgan, MS, PSRS
• Lavada Stacy Myers, BS
• Gaylen L. Newton, RN

• Case Manager/Care Coordinator in Boley, OK
• Providers in Boley, OK by specialty
• Case Manager/Care Coordinator in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.

Verify at the official NPI Registry.