Mandie Leigh Renner, CCNS

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

80137 Issued in OK

Practice address

1120 S Utica Ave Ste 2123
Tulsa, OK 74104

Phone

(918) 579-5402

Fax

(918) 579-5404

NPI assigned

Aug 28, 2008

Last updated

Mar 6, 2019By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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: mrenner199815@ahs.direct-ci.com

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.

• Northwest Benton County Physician Services LLC

  • Family Medicine Physician
  • Bentonville, AR
  • NPI 1871553073
  Medicare reassignment NPD
• Northwest Physicians LLC

  • Obstetrics Physician
  • Springdale, AR
  • NPI 1194768721
  Medicare reassignment NPD
• Northwest Physicians LLC

  • Durable Medical Equipment & Medical Supplies
  • Springdale, AR
  • NPI 1205137536
  NPD

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1760630131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE STE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "189-579-5402",
            "fax_number": "918-579-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE STE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8607 E. 104th St",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "74113",
            "country_code": "US",
            "telephone_number": "918-808-1881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENNER",
        "first_name": "MANDIE",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "CCNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-28",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SN0000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Neonatal",
            "state": "OK",
            "license": "81378",
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "OK",
            "license": "80137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Renfro
• Machelle Frances Renfro
• Gini A Renfrow, APRN-NP
• Raine Leigh Renfrow, RDLD
• Angel Marie Renn
• Rachel Rennie
• Gamal H. Renteria-Lucius, RPT
• Monique Rentie
• Megan Elizabeth Renz, APRN-CNS
• Jasmine Repp

• Critical Care Neonatal Nurse Practitioner in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Critical Care Neonatal Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.