THACKERVILLE MEDICAL CLINIC (NPI# 1518282185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518282185 |
| Entity Type | Organization |
| Organization Name | THACKERVILLE MEDICAL CLINIC |
| Practice Address |
11530 Ridge Rd Ste 1 Thackerville OK 73459-9771 |
| Practice Telephone | 5802769066 |
| Practice Fax Number | 5802769063 |
| Mailing Telephone | 5802769066 |
| Mailing Fax Number | 5802769063 |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2012-04-12 |
| Authorized Official Name | MRS. DANA CAROL SPROTT (NURSE PRACTITIONER/OWNER) |
| Authorized Official Telephone | 9403660180 |
| Authorized Official Credential | ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R0096598 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | THACKERVILLE MEDICAL CLINIC, PLLC | 100 Ridge Rd Ste 100, Thackerville, OK 73459 |
| Street Address |
11530 RIDGE RD STE 1 |
| City | THACKERVILLE |
| State | OK |
| Zip Code | 73459-9771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366938391 | Stephanie Dawnita Sampson | Nurse Practitioner | 11530 Ridge Rd Ste 1, Thackerville, OK 73459-9623 | 2018-07-02 |
| 1669777058 | Thackerville Pharmacy | Pharmacy | 11530 Ridge Rd Ste 1, Thackerville, OK 73459-9623 | 2011-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467655381 | Casey Jon Hucks | Counselor | 777 Casino Ave, Benefits Dept, Thackerville, OK 73459 | 2007-06-07 |
| 1962568410 | Nicole Anita Brown | Counselor | Strong Foundation - Thackerville, 777 Casino Ave, Thackerville, OK 73459 | 2006-12-29 |
| 1629351846 | Thackerville Public Schools | Local Education Agency (LEA) | Hwy 77 and Hwy 153, Thackerville, OK 73459-0377 | 2011-09-23 |
| 1780184697 | Rainey Jo Hitt | Registered Nurse | 11806 Harbor View St, Thackerville, OK 73459-9405 | 2018-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780184697 | Rainey Jo Hitt | Registered Nurse | 11806 Harbor View St, Thackerville, OK 73459-9405 | 2018-02-16 |
| 1629351846 | Thackerville Public Schools | Local Education Agency (LEA) | Hwy 77 and Hwy 153, Thackerville, OK 73459-0377 | 2011-09-23 |
| 1467655381 | Casey Jon Hucks | Counselor | 777 Casino Ave, Benefits Dept, Thackerville, OK 73459 | 2007-06-07 |
| 1962568410 | Nicole Anita Brown | Counselor | Strong Foundation - Thackerville, 777 Casino Ave, Thackerville, OK 73459 | 2006-12-29 |
| 1366938391 | Stephanie Dawnita Sampson | Nurse Practitioner | 11530 Ridge Rd Ste 1, Thackerville, OK 73459-9623 | 2018-07-02 |
| 1669777058 | Thackerville Pharmacy | Pharmacy | 11530 Ridge Rd Ste 1, Thackerville, OK 73459-9623 | 2011-01-18 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366938391 | Stephanie Dawnita Sampson | Nurse Practitioner | 11530 Ridge Rd Ste 1, Thackerville, OK 73459-9623 | 2018-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992306708 | Paula Sue Brown | Nurse Practitioner | 1020 N Lawson Blvd, Clayton, OK 74536-0219 | 2020-11-06 |
| 1235730581 | Cynthia Nanett Smith | Nurse Practitioner | 3009 24th Ave Se, Norman, OK 73071-1731 | 2020-11-03 |
| 1942801246 | Preston Craig | Nurse Practitioner | 1114 Mockingbird Ln, Norman, OK 73071-4838 | 2020-11-03 |
| 1528668530 | William Zachary Mccormick | Nurse Practitioner | 9900 Ashley Pl, The Village, OK 73120-3608 | 2020-10-28 |
| 1457951519 | Crystal Marie Mapes | Nurse Practitioner | 1920 E 2nd St Apt 4015, Edmond, OK 73034-6385 | 2020-10-28 |
| 1164021655 | Alana Christine Mckinney | Nurse Practitioner | 19400 Sw 44th St, El Reno, OK 73036-8191 | 2020-10-26 |
| 1063011831 | Venvisor Health Oklahoma LLC | Nurse Practitioner | 1831 E 71st St # 4213, Tulsa, OK 74136-3922 | 2020-10-22 |
| 1164021150 | Timber Laine Jackson | Nurse Practitioner | 1391 County Road 1215, Tuttle, OK 73089-3047 | 2020-10-20 |
| 1225637465 | Dakota Bell Morton | Nurse Practitioner | 208 W 35th St, Sand Springs, OK 74063-2832 | 2020-10-19 |
| 1942808746 | Shari E Stapleton | Nurse Practitioner | 324 Ceder Ln, Tuttle, OK 73089-8675 | 2020-10-14 |
| Find all providers with the same taxonomy | ||||
| City | THACKERVILLE |
| Zip Code | 73459 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.