Individual provider Active NPI

Nyediang Salome Ateghang, FNP, RN

  • Family Nurse Practitioner
  • Washington, DC
National Provider Identifier
1093288532
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R199045 Issued in MD
Practice address
110 Irving St NW
Washington, DC 20010-3017
Phone
(202) 877-7000
NPI assigned
Jan 8, 2019
Last updated
Oct 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R199045 MD Primary

Addresses

Primary practice location

110 Irving St NW
Washington, DC 20010-3017

Mailing address

1006 Kings Heather Dr
Bowie, MD 20721-2010
Phone (240) 838-2560

Other names 1

  • Nyediang Salome Ateghang Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20211202002416 MD Order and Referring Only - Nurse Practitioner 3678971520

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R199045MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Owensville Primary Care, Inc Single Specialty Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EAGCDD/Endpoint/EAGCDD

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1093288532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 KINGS HEATHER DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207212010",
            "telephone_number": "240-838-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 IRVING ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200103017",
            "telephone_number": "202-877-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATEGHANG",
        "first_name": "NYEDIANG",
        "middle_name": "SALOME",
        "name_prefix": "Mrs.",
        "credential": "FNP, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R199045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NYEDIANG",
            "last_name": "ATEGHANG",
            "middle_name": "SALOME",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.