Individual provider Active NPI

Ashley Dorner Nix, CRNP

  • Gerontology Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1922628239
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
207621 Issued in OK
Practice address
4205 McAuley Blvd Ste 375
Oklahoma City, OK 73120-9309
Phone
(405) 749-4247
Fax
(405) 749-4249
NPI assigned
Apr 17, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 207621 OK Primary

Addresses

Primary practice location

4205 McAuley Blvd Ste 375
Oklahoma City, OK 73120-9309

Mailing address

4205 McAuley Blvd Ste 375
Oklahoma City, OK 73120-9309
Phone (405) 749-4247

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
I20220822001641 OK Practitioner - Nurse Practitioner 7719360916 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total WellnessGroup PAC ID 4587986005, 4 clinicians

Practice addresses (Care Compare)

7017 N Robinson Ave
Oklahoma City, OK 73116-9044
Phone (405) 810-8677

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
207621OKMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities CurrentSince Aug 22, 2022 Accepting new patients
Total Wellness CurrentSince Jan 1, 2025 Accepting new patients

Locations

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

7017 N Robinson Ave
Oklahoma City, OK 73116
Phone (405) 658-3130

4205 McAuley Blvd
Ste 375
Oklahoma City, OK 73120
Phone (405) 749-4247

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1922628239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 MCAULEY BLVD STE 375",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731209309",
            "telephone_number": "405-749-4247",
            "fax_number": "405-749-4249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 MCAULEY BLVD STE 375",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731209309",
            "telephone_number": "405-749-4247",
            "fax_number": "405-749-4249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIX",
        "first_name": "ASHLEY",
        "middle_name": "DORNER",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OK",
            "license": "207621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.