| Pine Ridge Mental Healthcare, LLC | |
|
8418 N 123rd East Ave Owasso OK 74055-2139 | |
| (918) 858-4353 | |
| Not Available |
| Full Name | Pine Ridge Mental Healthcare, LLC |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8418 N 123rd East Ave, Owasso, Oklahoma |
| Authorized Official Name and Position | Nicole Mason (OWNER) |
| Authorized Official Contact | 6187818686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Ridge Mental Healthcare, LLC 8418 N 123rd East Ave Owasso OK 74055-2139 Ph: (918) 858-4353 | Pine Ridge Mental Healthcare, LLC 8418 N 123rd East Ave Owasso OK 74055-2139 Ph: (918) 858-4353 |
| NPI Number | 1346828050 |
|---|---|
| Provider Enumeration Date | 04/01/2021 |
| Last Update Date | 04/06/2026 |
| Certification Date | 04/06/2026 |
| Medicare PECOS PAC ID | 2062812043 |
|---|---|
| Medicare Enrollment ID | O20210614000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346828050 | NPI | - | NPPES |
| Provider Name | Curtis C Martinez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1073836235 PECOS PAC ID: 6204071897 Enrollment ID: I20130403000010 |
| Provider Name | Tamme Marie Saffa |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154392702 PECOS PAC ID: 6901102730 Enrollment ID: I20160304000369 |
| Provider Name | Amanda J Partridge |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689027237 PECOS PAC ID: 2567750979 Enrollment ID: I20171006001903 |
| Provider Name | Nicole Marie Mason |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1528173028 PECOS PAC ID: 4183729486 Enrollment ID: I20180917001021 |
| Provider Name | Wanjiru Landers |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881160356 PECOS PAC ID: 2860812179 Enrollment ID: I20230922003718 |
| Provider Name | Ilona Willyard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154687697 PECOS PAC ID: 4284088766 Enrollment ID: I20231003000560 |
| Provider Name | Tammy Jo Coletta |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376766972 PECOS PAC ID: 6507201068 Enrollment ID: I20240223003987 |
| Provider Name | Kayci Berlyn Moushon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962203778 PECOS PAC ID: 1052823721 Enrollment ID: I20250626002661 |
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