NPIMap

Organization Active NPI

Citizen Potawatomi Nation

Doing business as Citizen Potawatomi Nation Clinic Pharmacy

  • Clinic/Center
  • Shawnee, OK
National Provider Identifier
1689680670
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
10-4078 Issued in OK
Legal business name
CITIZEN POTAWATOMI NATION
Practice address
2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone
(405) 273-5236
Fax
(405) 273-2392
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Aubry Bennett, CPC-A
Title
Business Office Coordinator
Phone
(405) 964-4025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 10-4078 OK Primary

Addresses

Primary practice location

2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007

Mailing address

2307 Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone (405) 273-5236

Other identifiers 1

IdentifierTypeStateIssuer
100244300AMedicaidOK

Other names 1

  • citizen potawatomi nation clinic pharmacy Other name

National Provider Directory

National Provider Directory
Tax ID family
Tribal Affairs Citizen Band4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1689680670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748019007",
            "telephone_number": "405-273-5236",
            "fax_number": "405-273-2392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 S GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748019007",
            "telephone_number": "405-273-5236",
            "fax_number": "405-273-2392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZEN POTAWATOMI NATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "AUBRY",
        "authorized_official_title_or_position": "BUSINESS OFFICE COORDINATOR",
        "authorized_official_telephone_number": "405-964-4025",
        "authorized_official_credential": "CPC-A"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OK",
            "license": "10-4078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244300A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citizen Potawatomi Nation Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "citizen potawatomi nation clinic pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.