Individual provider Active NPI

Tessa Lynn Longan, APRN-CNP

  • Obstetrics & Gynecology Nurse Practitioner
  • Grove, OK
National Provider Identifier
1639511157
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
83227 Issued in OK
Practice address
900 E 13TH St
Suite 205
Grove, OK 74344-2975
Phone
(918) 786-2720
Fax
(918) 786-8020
NPI assigned
Jul 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 83227 OK Primary

Addresses

Primary practice location

900 E 13TH St
Suite 205
Grove, OK 74344-2975

Mailing address

5300 N Independence Ave
280
Oklahoma City, OK 73112-5556
Phone (918) 786-2720

Other identifiers 2

IdentifierTypeStateIssuer
200468380XMedicaidOK
200504950AMedicaidOK

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
I20131227000329 OK Practitioner - Nurse Practitioner 1355578139 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation CurrentSince Dec 15, 2013 Accepting new patients

Locations

115 W 13th St
Grove, OK 74344
Phone (918) 786-2226

900 E 13th St
Ste 205
Grove, OK 74344
Phone (918) 786-2720

5300 N Independence Ave
Ste 280
Oklahoma City, OK 73112
Phone (405) 552-0155

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

Interoperability endpoints

  • Direct secure messaging: tlongan11734@direct.integrisok.com

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

NPI Registry JSON

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

{
    "created_epoch": "1374710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491350400000",
    "number": "1639511157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE",
            "address_2": "280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "918-786-2720",
            "fax_number": "918-786-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E 13TH ST",
            "address_2": "SUITE 205",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442975",
            "telephone_number": "918-786-2720",
            "fax_number": "918-786-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGAN",
        "first_name": "TESSA",
        "middle_name": "LYNN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-25",
        "last_updated": "2017-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "OK",
            "license": "83227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200468380X",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200504950A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grove, OK

Sources for this page

Verify at the official NPI Registry.