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Dominque Latreace Wathan , CMII, BHWC

Case Manager/Care Coordinator β€’ Shawnee, OK

Active NPI 1992349427 Individual Practitioner Female Practitioner
Practice location in NPPES

111 W. 1st St
Shawnee, OK 748042202

Call 4052731170 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

111 W. 1st St

Shawnee, OK 748042202

Telephone 4052731170
Fax 4052416447
Organization at the Same NPPES Address or Phone
Gateway To Prevention And Recovery, Inc. Facility NPI 1144331802

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2019

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Shawnee and Oklahoma

144 active clinicians are listed under Case Manager/Care Coordinator with a practice address in Shawnee, OK (8,838 in Oklahoma).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Shawnee

0% of these 144 clinicians have the CMS telehealth indicator.

0% of these 144 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-03-04
Case Manager/Care Coordinator Primary Specialty

NUCC Taxonomy Code: 171M00000X

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.

Peer Specialist

NUCC Taxonomy Code: 175T00000X

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oklahoma State Board of Medical Licensure.
Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

12 Historical Events
πŸ“
Updated Business Mailing Address March 04, 2025

Registered at 111 W 1ST ST, CHANDLER, OK 748342004 (Tel: 4052731170)

πŸ‘€
Provider Name / Credentials Updated March 04, 2025

Recorded as DOMINQUE WATHAN, CMII, BHWC

πŸ“
Updated Practice Location January 16, 2025

Registered at 111 W. 1ST ST, SHAWNEE, OK 748042202 (Tel: 4052731170)

πŸ“
Updated Business Mailing Address January 16, 2025

Registered at 111 W. 1ST ST, SHAWNEE, OK 748042202 (Tel: 4052731170)

πŸ‘€
Provider Name / Credentials Updated January 16, 2025

Recorded as DOMINQUE WATHAN

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) January 16, 2025

Peer Specialist

βœ…
NPI Profile Active October 28, 2019

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) October 28, 2019

Registered at 1010 E 45TH ST, SHAWNEE, OK 748042202 (Tel: 4052731170)

πŸ“
Business Mailing Address (Initial Record) October 28, 2019

Registered at 1010 E 45TH ST, SHAWNEE, OK 748042202 (Tel: 4052731170)

πŸ‘€
Provider Name / Credentials (Initial Record) October 28, 2019

Recorded as DOMINQUE SIMMONS

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) October 28, 2019

Assistant Behavior Analyst

🟒
Initial NPI Registration & Enumeration October 28, 2019

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1992349427
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 28, 2019
Last Update: March 04, 2025
Sole Proprietor: No

Mailing Address

111 W 1st St

Chandler, OK 748342004

Phone: 4052731170

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.