Julia Wambolt, APRN-CNP,CNM,,IBCLC

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

205817 Issued in OK

Practice address

731 12TH Ave NW Ste 201
Ardmore, OK 73401-5764

Phone

(580) 226-3003

Fax

(580) 298-3124

NPI assigned

Dec 13, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OK, GA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment Care Compare group NPD
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1750314183
  Medicare reassignment NPD
• Curtis V. Cooper Primary Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, GA
  • NPI 1023804150
  NPD
• Curtis V. Cooper Primary Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1841683067
  NPD
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1659668010
  NPD
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• Mercy Hospital Ardmore, Inc.

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1386741635
  NPD (past)
• Mercy Hospital Oklahoma City, Inc

  • Diagnostic Radiology Physician
  • Yukon, OK
  • NPI 1730326406
  NPD (past)
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1316972599
  NPD (past)

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

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1346951076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 12TH AVE NW STE 201",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015764",
            "telephone_number": "580-226-3003",
            "fax_number": "580-298-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 12TH AVE NW STE 201",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015764",
            "telephone_number": "580-226-3003",
            "fax_number": "580-298-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAMBOLT",
        "first_name": "JULIA",
        "credential": "APRN-CNP,CNM,,IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-13",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "OK",
            "license": "R0044894",
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "OK",
            "license": "205817",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "OK",
            "license": "205817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "julia.wambolt@mercy.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "731 12th Ave NW Ste 201",
            "city": "Ardmore",
            "state": "OK",
            "country_code": "US",
            "postal_code": "734015764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Phillip Washington III, D.D.S.

• Women's Health Nurse Practitioner in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Women's Health Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.