Maria Gabriella Prudhomme, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

210652 Issued in OK

Practice address

1000 NE 13TH St # 1C
Oklahoma City, OK 73104-5040

Phone

(405) 271-6110

NPI assigned

Aug 5, 2014

Last updated

Mar 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gprudhomme@sanovaderm.emadirect.md
• Direct secure messaging: mprudhomme@directaddress.net

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.

• Michael D John MD PC

  • Dermatology Physician
  • Edmond, OK
  • NPI 1912043019
  Medicare reassignment NPD
• Ou Health Partners, Inc

  dba Ou Health Partners

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1528642642
  Medicare reassignment NPD
• Elizabeth Parro Gawey MD PC

  • Dermatology Physician
  • Oklahoma City, OK
  • NPI 1306121413
  Medicare reassignment
• Ou Health Partners, Inc

  dba OUHP Orthotics & Prosthetic

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1447834460
  NPD
• Bopp Dermatology and Facial Plastic Surgery

  • Specialist
  • Metairie, LA
  • NPI 1699148882
  NPD (past)

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1710396718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 NE 13TH ST STE 1C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045040",
            "telephone_number": "405-271-5992",
            "fax_number": "405-271-5992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 NE 13TH ST # 1C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045040",
            "telephone_number": "405-271-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDHOMME",
        "first_name": "MARIA",
        "middle_name": "GABRIELLA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-05",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN213432",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1067064",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN213432",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1067064",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "210652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Home Care LLC
• Provincial Home Care (Community Hospice of Oklahoma)
• Provision Cares Proton Center Okc, LLC
• Provision Medical Supplies, Inc.
• Jessica Rae Provost, APRN
• Geoffrey Allen Pruett, D.M.D.
• Pruett's Food, Inc. (Buy for Less Pharmacy (Pruett's Lake Hefner))
• Aubrey Leigh Pruitt
• Garland Pruitt
• Margarette Pruitt, MD

• Family Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.