Annika Elizabeth Dethlefs, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95023461 Issued in CA

Practice address

82 Clarksville Rd Ste 120
Folsom, CA 95630-8210

Phone

(916) 983-8868

NPI assigned

Nov 30, 2022

Last updated

Jan 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Annika Elizabeth Newman Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Vanderbilt University School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Healthy Living Primary Care IncGroup PAC ID 7618062225, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: adethlefs137646@hpmg.direct-ci.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthy Living Primary Care, Inc

  • Family Medicine Physician
  • Folsom, CA
  • NPI 1144414293
  Medicare reassignment Care Compare group NPD
• Healthy Living Primary Care, Inc

  • Family Medicine Physician
  • Fair Oaks, CA
  • NPI 1467996686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705276800000",
    "number": "1013627165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 WILSON BLVD APT 1331",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627262",
            "telephone_number": "916-817-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 CLARKSVILLE RD STE 120",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956308210",
            "telephone_number": "916-983-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHLEFS",
        "first_name": "ANNIKA",
        "middle_name": "ELIZABETH",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-30",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95023461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNIKA",
            "last_name": "NEWMAN",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anastasia P Dertlieva-Popova, PA
• Melissa Deryk
• Vaishali Desai, M.D.
• Taylor K Desilva
• Destiny Health Clinic LLC
• Dennis Alan Devine, PH.D.
• Tia Lynne Dew
• Vandana Dhanda, FNP
• Amandeep Singh Dhillon, M.D.
• Harpreet S Dhillon, MD

• Family Nurse Practitioner in Folsom, CA
• Providers in Folsom, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.