Individual provider Active NPI

Jacee Diana Harcourt, ARNP

  • Pediatric Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1295014595
Registry record updated Aug 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
86705 Issued in OK
Practice address
1200 N Phillips Ave
Oklahoma City, OK 73104-4600
Phone
(405) 271-5884
Fax
(405) 271-1151
NPI assigned
Aug 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 86705 OK Primary

Addresses

Primary practice location

1200 N Phillips Ave
Oklahoma City, OK 73104-4600

Mailing address

2444 Huntleigh Dr
Oklahoma City, OK 73120-3630
Phone (405) 609-4513

Other names 1

  • Jacee Diana Shepard Former name

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
I20111006000661 OK Practitioner - Nurse Practitioner 2860664257 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 4, 2011 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 4, 2011 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Ou Medicine Inc. Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

1200 Childrens Ave
Ste 9E
Oklahoma City, OK 73104
Phone 405271800131231

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

1200 Childrens Ave
#9E
Oklahoma City, OK 73104
Phone (572) 244-0040

1200 N Phillips Ave
Oklahoma City, OK 73104
Phone (405) 271-2244

Organizations & group practices 6

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": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1295014595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2444 HUNTLEIGH DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731203630",
            "telephone_number": "405-609-4513",
            "fax_number": "405-271-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N PHILLIPS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731044600",
            "telephone_number": "405-271-5884",
            "fax_number": "405-271-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARCOURT",
        "first_name": "JACEE",
        "middle_name": "DIANA",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OK",
            "license": "86705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACEE",
            "last_name": "SHEPARD",
            "middle_name": "DIANA",
            "credential": "ARNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.