Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

State of Oklahoma

Psychiatric Hospital in Fort Supply, OK · enumerated 2006 · authorized official Autumn Nickelson, Executive Director.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1922171701

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Registry record

Entity type Organization (Type 2)

Legal business name State of Oklahoma

Other name <Unavail>

Practice address 193461 E Ct Rd 304, Fort Supply, OK, 73841

Phone (580) 766-2311

Fax (580) 766-2017

Enumeration date Nov 17, 2006

Last updated in NPPES Dec 11, 2023

Taxonomy & classification

283Q00000X Psychiatric Hospital Hospitals Primary

Authorized official

Name Autumn Nickelson

Title Executive Director

Phone (580) 571-3231

Other identifiers

Identifier	Type	State	Issuer
100704080B	Medicaid	OK	-
100704080A	Medicaid	OK	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2023-12-11. Verify at npiregistry.cms.hhs.gov.

Where is State of Oklahoma located?

The practice location on file with NPPES is in Fort Supply, OK.

Providers at this address

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Northwest Center for Behavioral Health Institutional Pharmacy · Fort Supply, OK NPI 1710174107

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2023-12-11.