Individual provider Active NPI

Misty Lovely

  • Licensed Practical Nurse
  • Ogdensburg, NY
National Provider Identifier
1104295708
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
311492 Issued in NY
Practice address
1003 Park St
Ogdensburg, NY 13669-3911
Phone
(315) 713-9090
Fax
(315) 713-9330
NPI assigned
Sep 24, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 311492 NY Primary

Addresses

Primary practice location

1003 Park St
Ogdensburg, NY 13669-3911

Mailing address

56 Market St
Potsdam, NY 13676-1747
Phone (315) 265-4065

Other practice location 1

56 Market St
Potsdam, NY 13676-1747
Phone (315) 265-4065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
311492NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Citizen Advocates, Inc CurrentSince Aug 18, 2025 Accepting new patients
Health Services of Northern New York Past Accepting new patients

Locations

1003 Park St
Ogdensburg, NY 13669
Phone (315) 713-9090

Organizations & group practices 2

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": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1104295708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 MARKET ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761747",
            "telephone_number": "315-265-4065",
            "fax_number": "315-265-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 PARK ST",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136693911",
            "telephone_number": "315-713-9090",
            "fax_number": "315-713-9330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "56 Market St",
            "address_purpose": "LOCATION",
            "city": "Potsdam",
            "state": "NY",
            "postal_code": "136761747",
            "country_code": "US",
            "telephone_number": "315-265-4065",
            "fax_number": "315-265-0012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOVELY",
        "first_name": "MISTY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-24",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "311492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogdensburg, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.