Active NPI
Ophelia Anderson
- Prevention Professional
- Berkeley, MO
National Provider Identifier
1235616301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- SE106
- Practice address
- 6121 N Hanley Rd
Berkeley, MO 63134-2003 - Phone
- (314) 615-6452
- Fax
- (314) 615-6832
- NPI assigned
- Jul 23, 2018
- Last updated
- Jul 23, 2018
- 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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | SE106 | MO | Primary |
Addresses
Primary practice location
6121 N Hanley Rd
Berkeley, MO 63134-2003
Mailing address
6121 N Hanley Rd
Berkeley, MO 63134-2003
Phone (314) 615-6452
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SE106 | MO | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532304000000",
"number": "1235616301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6121 N HANLEY RD",
"city": "BERKELEY",
"state": "MO",
"postal_code": "631342003",
"telephone_number": "314-615-6452",
"fax_number": "314-615-6832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6121 N HANLEY RD",
"city": "BERKELEY",
"state": "MO",
"postal_code": "631342003",
"telephone_number": "314-615-6452",
"fax_number": "314-615-6832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "OPHELIA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-23",
"last_updated": "2018-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "MO",
"license": "SE106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.