NPIMap

Individual provider Active NPI

Bobby Don Priddy Jr., APRN CNP

  • Family Nurse Practitioner
  • Tishomingo, OK
National Provider Identifier
1871097741
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0092060 Issued in OK
Practice address
610 E 24TH St
Tishomingo, OK 73460-3245
Phone
(580) 371-2343
Fax
(580) 218-8963
NPI assigned
Mar 23, 2018
Last updated
Jun 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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 R0092060 OK Primary

Addresses

Primary practice location

610 E 24TH St
Tishomingo, OK 73460-3245

Mailing address

610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 371-2343

Other identifiers 1

IdentifierTypeStateIssuer
200870040AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191115002235 TX Practitioner - Nurse Practitioner 2466884242 Reassigns benefits to 1 organization

Care Compare profile

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

Practice addresses (Care Compare)

610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 387-0509

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.07 of 100Reported as group
Quality
73.06
Improvement activities
40
Cost
69.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0092060OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Choctaw Nation of Oklahoma CurrentSince Oct 1, 2019 Accepting new patients
Family Health Center of Southern Oklahoma Inc Current Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Oct 1, 2019 Accepting new patients
Family Health Center of Southern Oklahoma Inc Past Accepting new patients
Choctaw Nation of Oklahoma Past Accepting new patients
Family Health Center of Southern Oklahoma Inc Past Accepting new patients

Locations

1585 W Liberty Rd
Atoka, OK 74525
Phone (580) 889-1981

1300 E Martin Luther King Dr
Broken Bow, OK 74728
Phone (580) 208-2204

107 E Post Ave
Coalgate, OK 74538
Phone (580) 927-2828

1801 Chukka Hina
Durant, OK 74701
Phone (580) 920-2100

410 N M St
Hugo, OK 74743
Phone (580) 326-7561

902 E Lincoln Rd
Idabel, OK 74745
Phone (580) 286-2600

1127 S George Nigh Expy
McAlester, OK 74501
Phone (800) 349-7026

109 Kerr Blvd
Poteau, OK 74953
Phone (918) 649-1100

2204 E Main St
Stigler, OK 74462
Phone (918) 967-9200

1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440

205 Dallas St
Talihina, OK 74571
Phone (918) 567-3636

610 E 24th St
Tishomingo, OK 73460
Phone (580) 371-2343

Interoperability endpoints

  • Direct secure messaging: bobby.priddy@fhcso.directbygreenway.com
  • Direct secure messaging: bpriddy19832@choctawnation.direct-ci.com
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73380

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1871097741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 E 24TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603245",
            "telephone_number": "580-371-2343",
            "fax_number": "580-218-8963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E 24TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603245",
            "telephone_number": "580-371-2343",
            "fax_number": "580-218-8963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDDY",
        "first_name": "BOBBY",
        "middle_name": "DON",
        "name_suffix": "Jr.",
        "credential": "APRN CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-23",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0092060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200870040A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

Verify at the official NPI Registry.