NPIMap

Individual provider Active NPI

Mackenzie Nolan, NP

  • Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1497221626
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R0109250 Issued in OK
Practice address
1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone
(405) 272-7000
NPI assigned
Oct 15, 2018
Last updated
Mar 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R0109250 OK Primary
Family Nurse Practitioner 363LF0000X 109250 OK

Addresses

Primary practice location

1000 N Lee Ave
Oklahoma City, OK 73102-1036

Mailing address

10000 Prosper Dr
Oklahoma City, OK 73151-8808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190705000487 OK Practitioner - Nurse Practitioner 8123353653 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emergency Physicians of Mid-America PCGroup PAC ID 2062638661, 86 clinicians
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone (405) 272-7000

2301 W I 35 Frontage Rd
Edmond, OK 73013-8515
Phone (405) 757-3365

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0109250OKMDNurse Practitioner
109250OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of Mid-America, P.C. Nurse Practitioner CurrentSince May 19, 2019 Accepting new patients
Emergency Services of Oklahoma PC Nurse Practitioner CurrentSince Oct 1, 2020 Accepting new patients
South Central Emergency Services PC Nurse Practitioner CurrentSince Aug 31, 2021 Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients
SSM Health Care of Oklahoma, Inc Past Accepting new patients

Locations

5000 Hopyard Rd
Ste 100
Pleasanton, CA 94588
Phone (800) 617-7717

1415 N Whisenant Dr
Duncan, OK 73533
Phone (580) 251-6657

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

4050 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 608-3200

1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270

1323 W 6th Ave
Stillwater, OK 74074
Phone (405) 372-1480

Organizations & group practices 6

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 5

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": "1539561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1497221626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 PROSPER DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731518808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N LEE AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731021036",
            "telephone_number": "405-272-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "MACKENZIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-15",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "R0109250",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "109250",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.