Individual provider Active NPI

Kristi Dawn Haney, APRN

  • Family Nurse Practitioner
  • Tahlequah, OK
National Provider Identifier
1235676966
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
69310 Issued in OK
Practice address
1310 E Boone St
Tahlequah, OK 74464-3338
Phone
(918) 456-7700
Fax
(918) 458-9314
NPI assigned
Jan 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

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 69310 OK Primary

Addresses

Primary practice location

1310 E Boone St
Tahlequah, OK 74464-3338

Mailing address

PO Box 751
Hulbert, OK 74441-0751
Phone (918) 772-3390

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
I20181109001061 OK Practitioner - Nurse Practitioner 6002160090 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69310OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Oklahoma Community Health Centers Inc CurrentSince Oct 25, 2018 Accepting new patients
Northeastern Oklahoma Community Health Centers, Inc CurrentSince Oct 25, 2018 Accepting new patients
Northeastern Oklahoma Community Health Centers Inc Current Accepting new patients
Northeastern Oklahoma Community Health Centers, Inc Past Accepting new patients
Northeastern Health System Past Accepting new patients

Locations

124 E Main St
Hulbert, OK 74441
Phone (918) 772-2879

1310 E Boone St
Tahlequah, OK 74464
Phone (918) 456-7700

1500 E Downing St
Ste 201
Tahlequah, OK 74464
Phone (918) 772-3390

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/932b43fb-c766-413c-a343-640549d20cb3/

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.

NPI Registry JSON

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1235676966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751",
            "city": "HULBERT",
            "state": "OK",
            "postal_code": "744410751",
            "telephone_number": "918-772-3390",
            "fax_number": "918-458-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E BOONE ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643338",
            "telephone_number": "918-456-7700",
            "fax_number": "918-458-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANEY",
        "first_name": "KRISTI",
        "middle_name": "DAWN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-19",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "69310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.