Active NPI
Patricia Heron
- Nurse Practitioner
- Grand Haven, MI
National Provider Identifier
1164530556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704237156
- Practice address
- 1091 S Beacon Blvd
Grand Haven, MI 49417-2607 - Phone
- (616) 604-0096
- NPI assigned
- Aug 27, 2006
- 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 | 4704237156 | MI | Primary |
Addresses
Primary practice location
1091 S Beacon Blvd
Grand Haven, MI 49417-2607
Mailing address
16051 Baird Dr
Spring Lake, MI 49456-2331
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4811777 | Medicaid | MI | |
| PH237156 | Other | BLUE CROSS BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214265600000",
"number": "1164530556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16051 BAIRD DR",
"city": "SPRING LAKE",
"state": "MI",
"postal_code": "494562331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1091 S BEACON BLVD",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "494172607",
"telephone_number": "616-604-0096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERON",
"first_name": "PATRICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-27",
"last_updated": "2008-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704237156",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4811777",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "PH237156",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.