Individual provider Active NPI

Renu Chacko, APRN

  • Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1417837436
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
225259 Issued in OK
Practice address
1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Phone
(405) 341-7009
NPI assigned
Sep 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 225259 OK Primary

Addresses

Primary practice location

1919 E Memorial Rd
Oklahoma City, OK 73131-1253

Mailing address

1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Phone (405) 341-7009

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
I20251207000111 OK Practitioner - Nurse Practitioner 3476046475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
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)

1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Phone (405) 341-7009

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
225259OKMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities Family Medicine CurrentSince Dec 1, 2025 Accepting new patients

Locations

1919 E Memorial Rd
Oklahoma City, OK 73131
Phone (405) 341-7009

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

Organizations & group practices 1

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": "1756857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1417837436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 E MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731311253",
            "telephone_number": "405-341-7009",
            "fax_number": "405-330-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 E MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731311253",
            "telephone_number": "405-341-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "RENU",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-03",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "225259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.