Individual provider Active NPI

Michelle Phillips Hubner, MD

  • Child & Adolescent Psychiatry Physician
  • Tulsa, OK
National Provider Identifier
1770658486
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
21330 Issued in OK
Practice address
4612 S Harvard Ave
Ste a
Tulsa, OK 74135-2908
Phone
(918) 747-5565
Fax
(918) 747-5568
NPI assigned
Nov 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 21330 OK
Child & Adolescent Psychiatry Physician 2084P0804X 21330 OK Primary

Addresses

Primary practice location

4612 S Harvard Ave
Ste a
Tulsa, OK 74135-2908

Mailing address

4612 S Harvard Ave
Ste a
Tulsa, OK 74135-2908
Phone (918) 747-5565

Other identifiers 1

IdentifierTypeStateIssuer
100026380AMedicaidOK

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21330OKMDCase Manager/Care Coordinator

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225152000000",
    "number": "1770658486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4612 S HARVARD AVE",
            "address_2": "STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352908",
            "telephone_number": "918-747-5565",
            "fax_number": "918-747-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 S HARVARD AVE",
            "address_2": "STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352908",
            "telephone_number": "918-747-5565",
            "fax_number": "918-747-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBNER",
        "first_name": "MICHELLE",
        "middle_name": "PHILLIPS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2008-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "21330",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OK",
            "license": "21330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100026380A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.