Individual provider Active NPI

Lisa Renea Pate, APRN-CNP

  • Family Nurse Practitioner
  • Ada, OK
National Provider Identifier
1710528674
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
104727 Issued in OK
Practice address
730 Finley Dr
Ada, OK 74820-5392
Phone
(580) 421-6470
NPI assigned
Oct 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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 104727 OK Primary

Addresses

Primary practice location

730 Finley Dr
Ada, OK 74820-5392

Mailing address

730 Finley Dr
Ada, OK 74820-5392
Phone (580) 421-6470

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL LandrumENT.com

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20191204000214 OK Practitioner - Nurse Practitioner 2163855271

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

730 Finley Dr
Ada, OK 74820-5392

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Boogers R US PLLC CurrentSince Nov 6, 2019 Accepting new patients

Locations

730 Finley Dr
Ada, OK 74820
Phone (580) 421-6470

415 W Guy Ave
Ofc
Pauls Valley, OK 73075
Phone (580) 421-6470

Organizations & group practices 1

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 2

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": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1710528674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 FINLEY DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748205392",
            "telephone_number": "580-421-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 FINLEY DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748205392",
            "telephone_number": "580-421-6470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATE",
        "first_name": "LISA",
        "middle_name": "RENEA",
        "name_prefix": "Mrs.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-02",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "104727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "LandrumENT.com",
            "affiliation": "N",
            "address_1": "730 Finley Dr",
            "city": "Ada",
            "state": "OK",
            "country_code": "US",
            "postal_code": "748205392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.