Active NPI
Annette Glass
- Peer Specialist
- Grove, OK
National Provider Identifier
1689449142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 73-1022204
- Practice address
- 32300 S. 625 Rd.
Grove, OK 74344 - Phone
- (918) 787-2242
- Fax
- (918) 674-5041
- NPI assigned
- Nov 15, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 73-1022204 | OK | Primary |
Addresses
Primary practice location
32300 S. 625 Rd.
Grove, OK 74344
Mailing address
31627 S 619 LN
Grove, OK 74344-5440
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 |
|---|---|---|---|
| 73-1022204 | OK | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700006400000",
"number": "1689449142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31627 S 619 LN",
"city": "GROVE",
"state": "OK",
"postal_code": "743445440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32300 S. 625 RD.",
"city": "GROVE",
"state": "OK",
"postal_code": "74344",
"telephone_number": "918-787-2242",
"fax_number": "918-674-5041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLASS",
"first_name": "ANNETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-15",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "73-1022204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grove, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.