MRS. RENISA UNDERWOOD (NPI# 1629480991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629480991 |
| Entity Type | Individual |
| Full Name | MRS. RENISA UNDERWOOD |
| Practice Address |
205 N. Main St Broken Bow OK 74728-0000 |
| Practice Telephone | 5805842478 |
| Practice Fax Number | 5805842478 |
| Mailing Telephone | 5805842478 |
| Mailing Fax Number | 5805842478 |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-05-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
205 N. MAIN ST |
| City | BROKEN BOW |
| State | OK |
| Zip Code | 74728-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265057251 | Heather Renee Payne | Counselor | 205 N. Main St, Broken Bow, OK 74728 | 2020-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730732926 | Natorrie D'atra Morris | Nurse Practitioner | Mccurtain Family Medical Clinic, 800 N Park Dr, Broken Bow, OK 74728 | 2019-07-17 |
| 1477925535 | Rebecca Stover | Nurse Practitioner | 813 Veterans Way, Broken Bow, OK 74728 | 2015-10-28 |
| 1023366614 | Tlc Family Clinic, LLC | Clinic/Center | 700 W. Jones, Tlc Family Clinic, LLC, Broken Bow, OK 74728 | 2012-08-29 |
| 1699925867 | Faith Lucille Phillips | Psychologist | 411 S. Park Drive, Broken Bow, OK 74728 | 2008-09-24 |
| 1396244109 | Erika Ann White | Counselor | 205 N Main St, Broken Bow, OK 74728 | 2018-02-07 |
| 1366954661 | Black Oak Clinic LLC | Clinic/Center | 110 W 1st St, Broken Bow, OK 74728 | 2017-10-26 |
| 1922467505 | Stover Family Clinic | Clinic/Center | 813 Veterans Way, Broken Bow, OK 74728 | 2016-02-11 |
| 1568820140 | Megan Elizabeth Black | Nurse Practitioner | 110 W 1st St, Broken Bow, OK 74728 | 2016-02-10 |
| 1578797221 | Kenneth G Ericksen | Chiropractor | 1605 S Park Dr, Broken Bow, OK 74728 | 2009-05-11 |
| 1780977462 | Broken Bow Health and Rehab LLC | Skilled Nursing Facility | 700 Jones St., Broken Bow, OK 74728-0130 | 2011-05-27 |
| Find all providers in zip 74728 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386288231 | Tammy Buckman | Case Manager/Care Coordinator | 111 Esplanade Dr, Broken Bow, OK 74728-6103 | 2019-11-04 |
| 1447799085 | Alora S Fulgium | Case Manager/Care Coordinator | 8908 Craig Rd, Broken Bow, OK 74728-5560 | 2017-02-15 |
| 1346660743 | Sheila Erickson | Case Manager/Care Coordinator | 323 S 7th Street, Broken Bow, NE 68822 | 2014-04-24 |
| 1932528007 | Jessica Pruitt | Case Manager/Care Coordinator | 1638 Old Golden Hwy, Broken Bow, OK 74728-6846 | 2014-04-15 |
| 1245668110 | Jade Chantelle Box | Case Manager/Care Coordinator | 1140 Indigo Rd, Broken Bow, OK 74728-5824 | 2013-10-31 |
| 1912341389 | Tabitha Nicole Ferguson | Case Manager/Care Coordinator | 407 E 10th St, Broken Bow, OK 74728-2323 | 2013-04-29 |
| 1437577889 | Deann Mcmurl | Case Manager/Care Coordinator | 205 Main St, Broken Bow, OK 74728-3975 | 2014-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205437134 | Anisah S Beasley | Case Manager/Care Coordinator | 24797 S Sh-66, Claremore, OK 74019 | 2020-11-06 |
| 1508467994 | Yenth Matilde Chaidez | Case Manager/Care Coordinator | 10409 Casa Linda, Oklahoma City, OK 73139-5510 | 2020-11-03 |
| 1093316655 | Shaylee Renee Freeman | Case Manager/Care Coordinator | 25285 S Hackamore Rd E, Claremore, OK 74019-2558 | 2020-11-02 |
| 1407456114 | Nicole Roberts | Case Manager/Care Coordinator | 2505 E Hartford Ave Apt 10, Ponca City, OK 74604-3009 | 2020-10-30 |
| 1598365553 | Sherman Julian Riddle | Case Manager/Care Coordinator | 100 W Main St # 4, Pawhuska, OK 74056-4149 | 2020-10-29 |
| 1760082523 | Alimot Shadia L Karim | Case Manager/Care Coordinator | 1330 N Classen Blvd Ste 314, Oklahoma City, OK 73106-6834 | 2020-10-29 |
| 1922608942 | Madison Brianne Boyd | Case Manager/Care Coordinator | 801 Park St, Chelsea, OK 74016-1426 | 2020-10-28 |
| 1376143669 | Taylor Austin Finch | Case Manager/Care Coordinator | 3500 S Peoria Ave, Tulsa, OK 74105-2529 | 2020-10-27 |
| 1336749852 | Reshanna Leshae Childs-russell | Case Manager/Care Coordinator | 10505 Windway Ave, Oklahoma City, OK 73162-8001 | 2020-10-26 |
| 1679172381 | Leah Rebecca Linton | Case Manager/Care Coordinator | 518 W Park St, Tecumseh, OK 74873-3027 | 2020-10-22 |
| Find all providers with the same taxonomy | ||||
| City | BROKEN BOW |
| Zip Code | 74728 |
Please comment or provide details below to improve the information on MRS. RENISA UNDERWOOD.
| 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.