Active NPI
Amy Carleen Negovan, CPNP
- Pediatric Nurse Practitioner
- Prescott, AZ
National Provider Identifier
1205909041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 164403
- Practice address
- 1003 Willow Creek Rd
Prescott, AZ 86301-1641 - Phone
- (928) 771-5662
- Fax
- (928) 771-5249
- NPI assigned
- Nov 17, 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 164403 | AZ | Primary |
Addresses
Primary practice location
1003 Willow Creek Rd
Prescott, AZ 86301-1641
Mailing address
13421 Jefferson Ave
Hawthorne, CA 90250-6019
Phone (310) 978-1467
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 Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164403 | AZ | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557100800000",
"number": "1205909041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13421 JEFFERSON AVE",
"city": "HAWTHORNE",
"state": "CA",
"postal_code": "902506019",
"telephone_number": "310-978-1467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 WILLOW CREEK RD",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011641",
"telephone_number": "928-771-5662",
"fax_number": "928-771-5249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEGOVAN",
"first_name": "AMY",
"middle_name": "CARLEEN",
"name_prefix": "Mrs.",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2019-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AZ",
"license": "164403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.