Mary Illig Minielly, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R0059137 Issued in OK

Practice address

8100 S. Walker Avenue
Building a
Oklahoma City, OK 73139-9404

Phone

(405) 632-4468

Fax

(405) 631-4964

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• Emergency Medicine Physicians of Tulsa County, LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1003098773
  Medicare reassignment NPD
• Usacs Observation Medicine Services of Oklahoma, LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1326739111
  Medicare reassignment NPD
• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment NPD
• Jason B. Sigmon, M.D., P.C.

  • Specialist
  • Oklahoma City, OK
  • NPI 1588688196
  NPD (past)

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1417086380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 S. WALKER AVENUE",
            "address_2": "BUILDING A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731399404",
            "telephone_number": "405-632-4468",
            "fax_number": "405-631-4964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 S. WALKER AVENUE",
            "address_2": "BUILDING A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731399404",
            "telephone_number": "405-632-4468",
            "fax_number": "405-631-4964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINIELLY",
        "first_name": "MARY",
        "middle_name": "ILLIG",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "R0059137",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OK",
            "license": "R0059137",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHCA",
            "identifier": "100130740A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONBDD",
            "identifier": "28812",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOONERCARE",
            "identifier": "100130740A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12317438",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1417086380",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "59137",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip Barton Miner, Jr., M.D.
• Linda Lou Miner, D.M.D
• Shawn L Miner, LCSW
• Therese D Miner, ARNP
• Parminder Minhas, M.D.
• Layla Sarahy Jaquez Minjarez
• Isaiah Minnis
• Cody J Minor
• Danielle Nicole Minor, LPTA
• Kayla Y Minor

• Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.