Holly Vanderhyde, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95011532 Issued in CA

Practice address

12364 Perris Blvd
Moreno Valley, CA 92557-7423

Phone

(605) 209-6421

NPI assigned

Apr 23, 2019

Last updated

Sep 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Practice roles

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.

• Destiny Hospice Care, Inc

  • Community Based Hospice Care Agency
  • Moreno Valley, CA
  • NPI 1194027672
  NPD (past)

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632528000000",
    "number": "1033773379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1593",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922861593",
            "telephone_number": "442-269-1027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12364 PERRIS BLVD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925577423",
            "telephone_number": "605-209-6421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "58471 Twenty Nine Palms Hwy",
            "address_2": "Ste 103",
            "address_purpose": "LOCATION",
            "city": "Yucca Valley",
            "state": "CA",
            "postal_code": "92284",
            "country_code": "US",
            "telephone_number": "760-895-1525",
            "fax_number": "760-832-6124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERHYDE",
        "first_name": "HOLLY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2021-09-25",
        "certification_date": "2021-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95011532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hvanderhyde@destinyhospicecare.com",
            "affiliation": "Y",
            "affiliationName": "Destiny Hospice and Palliative Care",
            "address_1": "12364 Perris Blvd",
            "city": "Moreno Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925577423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Michele Van Hal, MD
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• Aleksandra Vargas
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• Nurse Practitioner in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.