Individual provider Active NPI

Jordan Nicole Mahaney

  • Physician Assistant
  • Edmond, OK
National Provider Identifier
1457179715
Registry record updated Jan 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5714 Issued in OK
Practice address
14101 N Eastern Ave Ste F
Edmond, OK 73013-5860
Phone
(405) 271-5541
NPI assigned
Sep 26, 2024
Last updated
Jan 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5714 OK Primary

Addresses

Primary practice location

14101 N Eastern Ave Ste F
Edmond, OK 73013-5860

Mailing address

14101 N Eastern Ave Ste F
Edmond, OK 73013-5860
Phone (405) 271-5541

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
I20260210004313 OK Practitioner - Physician Assistant 2163901042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ou Health Partners IncGroup PAC ID 5991105876, 1,167 clinicians

Practice addresses (Care Compare)

14101 N Eastern Ave
Ou Health Physicians
Edmond, OK 73013-5859
Phone (572) 244-0202

900 NE 10TH St
Ouhp Family Medicine
Oklahoma City, OK 73104-5420
Phone (572) 244-0065

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5714OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Jan 12, 2026 Accepting new patients
Ou Health Partners, Inc CurrentSince Jan 12, 2026 Accepting new patients

Locations

14101 N Eastern Ave
Edmond, OK 73013
Phone (405) 340-1279

14101 N Eastern Ave
Ste F
Edmond, OK 73013
Phone (405) 271-5541

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1727308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767657600000",
    "number": "1457179715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14101 N EASTERN AVE STE F",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135860",
            "telephone_number": "405-271-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14101 N EASTERN AVE STE F",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135860",
            "telephone_number": "405-271-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHANEY",
        "first_name": "JORDAN",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-26",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "5714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.