Heather Lynne Provence, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ01289400 Issued in NJ

Practice address

890 Mountain Ave
Behavioral Health & Cognitive Therapy
New Providence, NJ 07974

Phone

(908) 277-8900

Fax

(908) 508-8919

NPI assigned

Jul 9, 2018

Last updated

Jul 3, 2023By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Summit Medical Group PAGroup PAC ID 5395642276, 1,204 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: heather.provence.1@21260.direct.athenahealth.com
• Direct secure messaging: heather.provence.1@2983.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Medical Group PA

  • Multi-Specialty Clinic/Center
  • Berkeley Heights, NJ
  • NPI 1942254347
  Medicare reassignment Care Compare group NPD
• Sun River Health Inc

  • Federally Qualified Health Center (FQHC)
  • Amenia, NY
  • NPI 1568526838
  Medicare reassignment NPD
• Westchester Medical Group, P.C.

  dba WESTMED Medical Group

  • Critical Care Medicine (Internal Medicine) Physician
  • Rye Brook, NY
  • NPI 1881653822
  Medicare reassignment NPD
• Summit Medical Group PA

  • Durable Medical Equipment & Medical Supplies
  • Hackensack, NJ
  • NPI 1043930555
  NPD
• Sun River Health Inc

  • Adult Day Care Clinic/Center
  • Bronx, NY
  • NPI 1740763275
  NPD
• Sun River Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Peekskill, NY
  • NPI 1619969458
  NPD
• The Westchester Medical Group PC

  dba Westmed Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Greenwich, CT
  • NPI 1790560878
  NPD

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1295221612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DIAMOND HILL RD",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079222104",
            "telephone_number": "908-273-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 MOUNTAIN AVE",
            "address_2": "BEHAVIORAL HEALTH & COGNITIVE THERAPY",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "07974",
            "telephone_number": "908-277-8900",
            "fax_number": "908-508-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCE",
        "first_name": "HEATHER",
        "middle_name": "LYNNE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402394-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01289400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05265370",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Provident Home Care, Inc (Provident Home Care)
• Valerie Kathleen Pyper
• Lucia Quiles, LPC
• Mariela Nohely Ramos

• Psychiatric/Mental Health Nurse Practitioner in New Providence, NJ
• Providers in New Providence, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.