Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

MRS. MARY GRACE DIFUNTORUM APRN, FNP
NPI 1659078129
Nurse Practitioner - Family in Moore, OK

Active since February 14, 2023PECOS EnrolledAccepts Medicare Assignment
400 N EASTERN AVE, MOORE, OK 73160(405) 730-6990(405) 730-6992 Get Directions Write a Review

NPPES record last updated: July 4, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Oct 9, 2024, Feb 14, 2023 (2 updates tracked since 2023).

About Mrs. Mary Grace Difuntorum Aprn, Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. MARY GRACE DIFUNTORUM APRN, FNP (NPI 1659078129) is an individual family provider in Moore, Oklahoma, licensed in Oklahoma (210920) and active in the NPI registry since February 2023. She is enrolled in Medicare PECOS, maintains a secondary practice location in Mustang, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1659078129
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. MARY GRACE DIFUNTORUMCredential: APRN, FNP
Location Address400 N EASTERN AVEMoore, OK 73160-5833
Mailing AddressPo Box 891625Oklahoma City, OK 73189-1625
Fax(405) 730-6992
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateFebruary 14, 2023
Last NPPES UpdateJuly 4, 20262 updates tracked since enumeration
NPPES CertifiedJuly 4, 2026
NPI 1659078129 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License Licensed in OK · 210920
400 N EASTERN AVE, Moore, OK 73160

Secondary Practice Location 1

Location 1160 E SW 59th StMustang, OK 73064-4722 · Phone (405) 730-6990 · Fax (405) 730-6992

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mrs. Mary Grace Difuntorum Aprn, Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305372681
PECOS Enrollment IDI20241210002877
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 73160 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$94.27 typical visit price
range $16.68 – $132.40
Typical copayment $23.56 (range $4.17 – $33.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Marriage & Family Therapist
400 N EASTERN AVE
MOORE, OK 73160
Nurse Practitioner (Pediatrics)
400 N EASTERN AVE
MOORE, OK 73160
Speech-Language Pathologist
400 N EASTERN AVE
MOORE, OK 73160
Occupational Therapy Assistant
400 N EASTERN AVE
MOORE, OK 73160
Occupational Therapy Assistant
400 N EASTERN AVE
MOORE, OK 73160
Occupational Therapist
400 N EASTERN AVE
MOORE, OK 73160
Counselor (Addiction (Substance Use Disorder))
400 N EASTERN AVE
MOORE, OK 73160
Physical Therapist (Pediatrics)
400 N EASTERN AVE
MOORE, OK 73160

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1659078129, enumerated as an "individual" on February 14, 2023.

The provider is located at 400 N EASTERN AVE MOORE, OK 73160 and the phone number is (405) 730-6990.

Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.

The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to verify.