Individual provider Active NPI

Andria Burnett

  • Family Nurse Practitioner
  • Broken Arrow, OK
National Provider Identifier
1447973532
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
215346 Issued in OK
Practice address
1751 N Aspen Ave
Broken Arrow, OK 74012-1197
Phone
(561) 420-4453
NPI assigned
Sep 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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 215346 OK Primary

Addresses

Primary practice location

1751 N Aspen Ave
Broken Arrow, OK 74012-1197

Mailing address

20291 E 33Rd St S
Broken Arrow, OK 74014-5157

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
I20240726000477 OK Practitioner - Nurse Practitioner 4587100581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pmo Medical PLLCGroup PAC ID 1153603832, 11 clinicians

Practice addresses (Care Compare)

1751 N Aspen Ave
Broken Arrow, OK 74012-1197
Phone (918) 794-6008

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
215346OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pmo Medical PLLC CurrentSince Jul 15, 2024 Accepting new patients
Pmo Medical PLLC CurrentSince Jul 15, 2024 Accepting new patients

Locations

1761 N Aspen Ave
Broken Arrow, OK 74012
Phone (918) 469-5267

1751 N Aspen Ave
Broken Arrow, OK 74012
Phone (561) 420-4453

1201 E Wade Watts Ave
McAlester, OK 74501

555 W Ruth Ave
Sallisaw, OK 74955
Phone (918) 774-0147

401 E Broadway Ct
Ste A
Sand Springs, OK 74063
Phone (918) 246-3456

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1447973532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20291 E 33RD ST S",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740145157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 N ASPEN AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740121197",
            "telephone_number": "561-420-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "ANDRIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-22",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "215346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.