Active NPI
Mimsie M Farrar, N.P.
- Family Nurse Practitioner
- Modesto, CA
National Provider Identifier
1114040029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- NP12314
- Practice address
- 3621 Forest Glenn Dr
Modesto, CA 95355-1339 - Phone
- (209) 521-7411
- Fax
- (209) 521-2640
- NPI assigned
- Apr 6, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP12314 | CA | Primary |
Addresses
Primary practice location
3621 Forest Glenn Dr
Modesto, CA 95355-1339
Mailing address
3621 Forest Glenn Dr
Modesto, CA 95355-1339
Phone (209) 521-7411
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP12314 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456272000000",
"number": "1114040029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 FOREST GLENN DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953551339",
"telephone_number": "209-521-7411",
"fax_number": "209-521-2640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3621 FOREST GLENN DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953551339",
"telephone_number": "209-521-7411",
"fax_number": "209-521-2640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRAR",
"first_name": "MIMSIE",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-06",
"last_updated": "2016-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "NP12314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; 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.