NPIMap

Individual provider Active NPI

Mikal Phillips Edwards, APRN-CNP

  • Family Nurse Practitioner
  • Cheyenne, OK
National Provider Identifier
1396234902
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
79957 Issued in OK
Practice address
101 F K Buster Ave
Cheyenne, OK 73628
Phone
(580) 497-3333
NPI assigned
May 9, 2018
Last updated
Dec 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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 79957 OK Primary

Addresses

Primary practice location

101 F K Buster Ave
Cheyenne, OK 73628

Mailing address

101 F K Buster Ave
Cheyenne, OK 73628
Phone (580) 497-3333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180619000759 OK Practitioner - Nurse Practitioner 3274888011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 S LL Males
Cheyenne, OK 73628
Phone (580) 497-3336

P O Box
Suite 490
Cheyenne, OK 73628-0490

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Roger Mills County Hospital Authority CurrentSince May 11, 2018 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients
Roger Mills County Hospital Authority Past Accepting new patients
Roger Mills County Hospital Authority Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1396234902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 F K BUSTER AVE",
            "city": "CHEYENNE",
            "state": "OK",
            "postal_code": "73628",
            "telephone_number": "580-497-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 F K BUSTER AVE",
            "city": "CHEYENNE",
            "state": "OK",
            "postal_code": "73628",
            "telephone_number": "580-497-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS EDWARDS",
        "first_name": "MIKAL",
        "name_prefix": "Mrs.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-09",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "79957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, OK

Sources for this page

Verify at the official NPI Registry.