Individual provider Active NPI

Jemmie Renah Mauk

  • Peer Specialist
  • Pryor, OK
National Provider Identifier
1508729518
Registry record updated Dec 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Practice address
501 N Taylor St TRLR 6
Pryor, OK 74361-2025
Phone
(918) 244-5711
NPI assigned
Dec 5, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X OK Primary

Addresses

Primary practice location

501 N Taylor St TRLR 6
Pryor, OK 74361-2025

Mailing address

501 N Taylor St TRLR 6
Pryor, OK 74361-2025
Phone (918) 244-5711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1764892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764892800000",
    "number": "1508729518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N TAYLOR ST TRLR 6",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743612025",
            "telephone_number": "918-244-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N TAYLOR ST TRLR 6",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743612025",
            "telephone_number": "918-244-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUK",
        "first_name": "JEMMIE",
        "middle_name": "RENAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-05",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pryor, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.