Individual provider Active NPI

Nola Larue Gibson, RN

  • Registered Nurse
  • Boley, OK
National Provider Identifier
1699008193
Registry record updated Sep 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R0028163 Issued in OK
Practice address
2 Miles East of Boley on Hwy 62
Boley, OK 74829
Phone
(918) 667-3367
Fax
(918) 667-3387
NPI assigned
Sep 15, 2009
Last updated
Sep 15, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R0028163 OK Primary

Addresses

Primary practice location

2 Miles East of Boley on Hwy 62
Boley, OK 74829

Mailing address

P. O. Box 218
Boley, OK 74829-0218
Phone (918) 667-3367

Other identifiers 2

IdentifierTypeStateIssuer
100685660AMedicaidOK
100685660DMedicaidOK

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R0028163OKMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Stepping Stones, Inc. Past Accepting new patients
Stepping Stones, Inc. Past Accepting new patients

Organizations & group practices 2

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": "1252972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252972800000",
    "number": "1699008193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 218",
            "city": "BOLEY",
            "state": "OK",
            "postal_code": "748290218",
            "telephone_number": "918-667-3367",
            "fax_number": "918-667-3387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MILES EAST OF BOLEY ON HWY 62",
            "city": "BOLEY",
            "state": "OK",
            "postal_code": "74829",
            "telephone_number": "918-667-3367",
            "fax_number": "918-667-3387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "NOLA",
        "middle_name": "LARUE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "R0028163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100685660A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100685660D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boley, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; 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.