Individual provider Active NPI

Jeffrey David Munholland, APRN-CNP

  • Family Nurse Practitioner
  • Ardmore, OK
National Provider Identifier
1669716353
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
89570 Issued in OK
Practice address
2510 Chickasaw Blvd
Ardmore, OK 73401-1341
Phone
(580) 226-8181
Fax
(580) 421-6283
NPI assigned
Nov 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 89570 OK Primary

Addresses

Primary practice location

2510 Chickasaw Blvd
Ardmore, OK 73401-1341

Mailing address

1925 Warrior Way
Ada, OK 74820-3491
Phone (580) 421-4570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20161025000491 TX Practitioner - Nurse Practitioner 4880838374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2510 Chickasaw Blvd
Ardmore, OK 73401-1341
Phone (580) 226-8181

Hospital & facility affiliations

  • Chickasaw Nation Medical Center Hospital, Ada, OK, CCN 370180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
89570OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Frelyn Loughridge Family Nurse Practitioner PC Family CurrentSince Aug 1, 2013 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Sep 22, 2016 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Sep 22, 2016 Accepting new patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center Past Accepting new patients

Locations

1925 Warrior Way
Ada, OK 74820

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1405 4th Ave NW
Ardmore, OK 73401
Phone (580) 226-5566

1025 15th Ave NW
Ardmore, OK 73401
Phone (580) 226-7673

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Interoperability endpoints

  • Direct secure messaging: jmunholland22820@direct.chickasawnationhealth.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1669716353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 WARRIOR WAY",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203491",
            "telephone_number": "580-421-4570",
            "fax_number": "580-421-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 CHICKASAW BLVD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011341",
            "telephone_number": "580-226-8181",
            "fax_number": "580-421-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNHOLLAND",
        "first_name": "JEFFREY",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-19",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "89570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.