Individual provider Active NPI

Drew Riley Henderson, APRN-CNP

  • Family Nurse Practitioner
  • Edmond, OK
National Provider Identifier
1407563323
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
202594 Issued in OK
Practice address
1208 W 15TH St
Edmond, OK 73013-3001
Phone
(405) 340-2100
Fax
(405) 340-1184
NPI assigned
Oct 31, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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 202594 OK Primary

Addresses

Primary practice location

1208 W 15TH St
Edmond, OK 73013-3001

Mailing address

1208 W 15TH St
Edmond, OK 73013-3001
Phone (405) 340-2100

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
I20230210000093 OK Practitioner - Nurse Practitioner 8123490653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1208 W 15TH St
Edmond, OK 73013-3001
Phone (405) 340-2100

Hospital & facility affiliations

  • Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County, Inc CurrentSince Nov 1, 2023 Accepting new patients
Mercy Hospital Logan County Inc CurrentSince Nov 1, 2023 Accepting new patients
Mercy Clinic Oklahoma Communities CurrentSince Feb 20, 2023 Accepting new patients

Locations

1208 W 15th St
Edmond, OK 73013
Phone (405) 340-2100

2919 S Division St
Guthrie, OK 73044
Phone (405) 282-6301

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1407563323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 W 15TH ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133001",
            "telephone_number": "405-340-2100",
            "fax_number": "405-340-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 W 15TH ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133001",
            "telephone_number": "405-340-2100",
            "fax_number": "405-340-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DREW",
        "middle_name": "RILEY",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-31",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "202594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.