Steven Wayne Bookout

Key facts

NPI

1417601428

Entity type

Individual (NPI type 1)

Primary specialty

Peer Specialist 175T00000X

Practice address

1904 N Union St Ste 103
Ponca City, OK 74601-1542

Phone

(580) 749-4178

NPI assigned

Feb 8, 2022

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 9, 2022.

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1417601428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 N UNION ST STE 103",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746011542",
            "telephone_number": "580-749-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 N UNION ST STE 103",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746011542",
            "telephone_number": "580-749-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOKOUT",
        "first_name": "STEVEN",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Ponca City, OK · Peer Specialist in Oklahoma