Mandy Koekemoer

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

222001 Issued in AR

Practice address

4713 Winged Foot LN
Jonesboro, AR 72405-8050

Phone

(870) 243-0418

NPI assigned

May 1, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Renew Mental Health and Wellness LLCGroup PAC ID 0345574737, 24 clinicians

Venvisor Health of Ar PAGroup PAC ID 8022551647, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mandy.koekemoer.1@32715.direct.athenahealth.com

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.

• Venvisor Health of Ar PA

  • Nurse Practitioner
  • Bentonville, AR
  • NPI 1992553028
  Medicare reassignment Care Compare group NPD
• Renew Mental Health and Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jonesboro, AR
  • NPI 1447817572
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667692800000",
    "number": "1164086559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 WINGED FOOT LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724058050",
            "telephone_number": "870-243-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 WINGED FOOT LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724058050",
            "telephone_number": "870-243-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEKEMOER",
        "first_name": "MANDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-01",
        "last_updated": "2022-11-06",
        "certification_date": "2022-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R69806",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "222001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seneca Knight
• Kenneth Knowlton, QBHP
• Whitney Knox
• Anna C Koch, PT
• Nichole Megan Koebernik
• Macie Koelling
• Jonathan Koh
• Savannah Kohler
• James M Kolarik, PHD
• Kolin E. Weaver, DDS, Ms, Inc.

• Family Nurse Practitioner in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.