Active NPI
Susan Nickelberry
- Peer Specialist
- Oklahoma City, OK
National Provider Identifier
1659803005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- R082786016
- Practice address
- 1316 SW Binkley St
Oklahoma City, OK 73119-2323 - Phone
- (405) 410-4226
- NPI assigned
- Apr 3, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | R082786016 | OK | Primary |
Addresses
Primary practice location
1316 SW Binkley St
Oklahoma City, OK 73119-2323
Mailing address
1316 SW Binkley St
Oklahoma City, OK 73119-2323
Phone (405) 410-4226
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R082786016 | OK | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491177600000",
"number": "1659803005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1316 SW BINKLEY ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731192323",
"telephone_number": "405-410-4226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 SW BINKLEY ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731192323",
"telephone_number": "405-410-4226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELBERRY",
"first_name": "SUSAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-03",
"last_updated": "2017-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "R082786016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.