Active NPI
Nancy Eaves, APRN
- Pediatric Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1255447645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 8720
- Practice address
- 3333 University Ave SE
Minneapolis, MN 55414-3325 - Phone
- (612) 767-7222
- NPI assigned
- Aug 21, 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 | 8720 | MN | Primary |
Addresses
Primary practice location
3333 University Ave SE
Minneapolis, MN 55414-3325
Mailing address
425 Big Bay Blvd
Lumberton, MS 39455-5938
Phone (601) 658-2640
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2478052 | Medicaid | LA | |
| 08278310 | Medicaid | MS | |
| 052841 | Other | LA | CDS |
| AP10074 | Other | LA | STATE LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8720 | MN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington St. Tammany Regional Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pharmacy
- Bogalusa, LA
- NPI 1801801436
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638748800000",
"number": "1255447645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 BIG BAY BLVD",
"city": "LUMBERTON",
"state": "MS",
"postal_code": "394555938",
"telephone_number": "601-658-2640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 UNIVERSITY AVE SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554143325",
"telephone_number": "612-767-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAVES",
"first_name": "NANCY",
"name_prefix": "Ms.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2021-12-06",
"certification_date": "2021-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "8720",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2478052",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08278310",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDS",
"identifier": "052841",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "AP10074",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.