Active NPI
Penny Mims, CNP
- Nurse Practitioner
- Ypsilanti, MI
National Provider Identifier
1104369610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704180055
- Practice address
- 5301 E Huron River Dr
Ypsilanti, MI 48197-1051 - Phone
- (734) 712-8676
- Fax
- (734) 712-3855
- NPI assigned
- Dec 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704180055 | MI | Primary |
Addresses
Primary practice location
5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Mailing address
24 Frank Lloyd Wright Dr
PO Box 0446 - Lobby J
Ann Arbor, MI 48105-9484
Phone (734) 747-6766
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
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704180055 | MI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480550400000",
"number": "1104369610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 FRANK LLOYD WRIGHT DR",
"address_2": "PO BOX 0446 - LOBBY J",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481059484",
"telephone_number": "734-747-6766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5301 E HURON RIVER DR",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481971051",
"telephone_number": "734-712-8676",
"fax_number": "734-712-3855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMS",
"first_name": "PENNY",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-01",
"last_updated": "2016-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704180055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ypsilanti, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.