Individual provider Active NPI

Jennie P Hiam

  • Family Nurse Practitioner
  • Evansville, IN
National Provider Identifier
1144229295
Registry record updated Mar 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71000431 Issued in IN
Practice address
907 SE 8TH St
Evansville, IN 47713-1530
Phone
(812) 436-0224
Fax
(812) 436-0230
NPI assigned
Jul 20, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2010

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 71000431 IN Primary

Addresses

Primary practice location

907 SE 8TH St
Evansville, IN 47713-1530

Mailing address

501 John St
Suite 12
Evansville, IN 47713-2705
Phone (812) 421-7489

Other identifiers 3

IdentifierTypeStateIssuer
000000328971OtherANTHEM BC/BS
100465880AMedicaidIN
351791786104OtherINCARESOURCE PROVIDER ID

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71000431INMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269561600000",
    "number": "1144229295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 JOHN ST",
            "address_2": "SUITE 12",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477132705",
            "telephone_number": "812-421-7489",
            "fax_number": "812-421-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 SE 8TH ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477131530",
            "telephone_number": "812-436-0224",
            "fax_number": "812-436-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIAM",
        "first_name": "JENNIE",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2010-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71000431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000328971",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100465880A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE PROVIDER ID",
            "identifier": "351791786104",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; 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.