Active NPI
Mickeeta Lashoone Rose
- Peer Specialist
- Oklahoma City, OK
National Provider Identifier
1396251179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 717 NE 79TH PL
Oklahoma City, OK 73114-4106 - Phone
- (405) 505-3598
- NPI assigned
- Dec 16, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
717 NE 79TH PL
Oklahoma City, OK 73114-4106
Mailing address
1200 NE 13TH St
Oklahoma City, OK 73117-1022
Phone (405) 248-9368
Other names 1
- Mickeeta Lashoone Holliman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513382400000",
"number": "1396251179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 NE 13TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731171022",
"telephone_number": "405-248-9368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 NE 79TH PL",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731144106",
"telephone_number": "405-505-3598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "MICKEETA",
"middle_name": "LASHOONE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-16",
"last_updated": "2017-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MICKEETA",
"last_name": "HOLLIMAN",
"middle_name": "LASHOONE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.