Individual provider Active NPI

Jennifer Ann Soper, WHNP

  • Obstetrics & Gynecology Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1063924926
Registry record updated May 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
4704191329 Issued in MI
Practice address
400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1599
Phone
(888) 731-8994
NPI assigned
Nov 1, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 4704191329 MI Primary

Addresses

Primary practice location

400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1599

Mailing address

2567 Bell Cir
Stevensville, MI 49127-8700
Phone (269) 876-1684

Other practice location 1

111 N Orange Ave Ste 800
Orlando, FL 32801-2381
Phone (888) 731-8994

Other practice location 2

21 E State St Ste 200
Columbus, OH 43215-0109
Phone (888) 731-8994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20171207000324 MI Practitioner - Nurse Practitioner 0749547321 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Methodist Hospital CurrentSince Dec 18, 2017 Accepting new patients
Integrative Womens Care PC Past Accepting new patients
Radiology Associates of Berrien County PC PastSince Dec 13, 2021 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

3300 W Centre Ave
Portage, MI 49024
Phone (269) 324-8950

Interoperability endpoints

  • Direct secure messaging: jennifer.soper.1@27069.direct.athenahealth.com

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1509494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746316800000",
    "number": "1063924926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2567 BELL CIR",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491278700",
            "telephone_number": "269-876-1684",
            "fax_number": "269-327-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RENAISSANCE CTR STE 2600",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482431599",
            "telephone_number": "888-731-8994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 N Orange Ave Ste 800",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328012381",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21 E State St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432150109",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOPER",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-01",
        "last_updated": "2025-05-04",
        "certification_date": "2025-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MI",
            "license": "4704191329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.