Pine Ridge Mental Healthcare, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

PINE RIDGE MENTAL HEALTHCARE, LLC

Practice address

8418 N 123Rd East Ave
Owasso, OK 74055-2139

Phone

(918) 858-4353

NPI assigned

Apr 1, 2021

Last updated

Oct 10, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nicole Mason, PANPI 1528173028

Title

Owner

Phone

(618) 781-8686

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: nicole.mason@org93.direct.charmhealth.com

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Mason, PA-C

  • Medical Physician Assistant
  • Owasso, OK
  • NPI 1528173028
  Medicare reassignment Care Compare group Authorized official
• Tammy Jo Coletta

  • Professional Counselor
  • Owasso, OK
  • NPI 1376766972

  Mental Health

  Medicare reassignment Care Compare group NPD
• Wanjiru Landers

  • Physician Assistant
  • Owasso, OK
  • NPI 1881160356
  Medicare reassignment Care Compare group NPD
• Curtis Ceasar Martinez, PA

  • Physician Assistant
  • Owasso, OK
  • NPI 1073836235
  Medicare reassignment Care Compare group NPD
• Kayci Moushon, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Owasso, OK
  • NPI 1962203778
  Medicare reassignment Care Compare group NPD
• Ilona Willyard, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Owasso, OK
  • NPI 1154687697
  Medicare reassignment Care Compare group NPD
• Amanda Partridge, P.A.-C

  • Physician Assistant
  • Owasso, OK
  • NPI 1689027237
  Medicare reassignment Care Compare group
• Tamme Marie Saffa, PA-C

  • Physician Assistant
  • Claremore, OK
  • NPI 1154392702
  Medicare reassignment Care Compare group
• Laren W Hightower, D.O.

  • Family Medicine Physician
  • Coweta, OK
  • NPI 1770676280
  NPD
• Danella Denise Johnson, BSBA/BSBM

  • Mental Health Counselor
  • Owasso, OK
  • NPI 1922547108
  NPD (past)
• Randy T Warner, M.D.

  • Psychiatry Physician
  • Villa Rica, GA
  • NPI 1144380056
  NPD (past)

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791590400000",
    "number": "1346828050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8418 N 123RD EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740552139",
            "telephone_number": "918-858-4353",
            "fax_number": "866-246-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8418 N 123RD EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740552139",
            "telephone_number": "918-858-4353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 W Blue Starr Dr",
            "address_purpose": "LOCATION",
            "city": "Claremore",
            "state": "OK",
            "postal_code": "740172638",
            "country_code": "US",
            "telephone_number": "918-858-4353",
            "fax_number": "866-246-2942",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "329 S Elm St Ste 240",
            "address_purpose": "LOCATION",
            "city": "Jenks",
            "state": "OK",
            "postal_code": "740373765",
            "country_code": "US",
            "telephone_number": "918-858-4353",
            "fax_number": "866-246-2942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINE RIDGE MENTAL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-01",
        "last_updated": "2026-10-10",
        "certification_date": "2026-10-10",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-781-8686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse's Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Owasso, OK
• Providers in Owasso, OK by specialty
• Psychiatry Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.