Prudencia A Ijeoma

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

210566 Issued in OK

Practice address

909 Alameda St
Norman, OK 73071-5229

Phone

(405) 360-5100

NPI assigned

Oct 29, 2021

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 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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

State of OklahomaGroup PAC ID 4486558962, 99 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• State of Oklahoma

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norman, OK
  • NPI 1588755532
  Medicare reassignment Care Compare group NPD
• Libertad Wellness Center LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1295583508
  NPD
• State of Oklahoma

  • Skilled Nursing Facility
  • Talihina, OK
  • NPI 1154589430
  NPD

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1891459376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730700400",
            "telephone_number": "405-360-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 ALAMEDA ST",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730715229",
            "telephone_number": "405-360-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IJEOMA",
        "first_name": "PRUDENCIA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-29",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "0123998",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OK",
            "license": "210566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonia G. Ice, M.S. CCC-SLP
• Ico Primary Care LLC
• Ideal Eye Care, P.C.
• Zain Iftikhar, MD
• Ignite Medical Resort Norman, LLC
• Josephine A. Ikpa
• Nicole Ashton Imes, CPM
• Immediate Care of Oklahoma LLC
• Immediate Care of Oklahoma LLC
• Immylabs, LLC

• Psychiatric/Mental Health Nurse Practitioner in Norman, OK
• Providers in Norman, OK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.