Active NPI
Mickki Renae Templeman, CFNP
- Nurse Practitioner
- Mt Pleasant, MI
National Provider Identifier
1356371777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704184401
- Practice address
- 411 W Broadway St
Suite a
Mount Pleasant, MI 48858-2402 - Phone
- (989) 772-9523
- Fax
- (989) 772-9052
- NPI assigned
- Jul 3, 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 | 4704184401 | MI | Primary |
Addresses
Primary practice location
411 W Broadway St
Suite a
Mount Pleasant, MI 48858-2402
Mailing address
411 W Broadway St
Suite a
Mt Pleasant, MI 48858-2446
Phone (989) 772-9523
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200000004572 | Other | MI | PHP COMMERCIAL |
| 4520134-11 | Medicaid | MI | |
| 1010137 | Other | MI | MCLAREN HEALTH PLAN |
| 5008701250 | Other | MI | BCBSM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190314000158 | MI | Order and Referring Only - Nurse Practitioner | 4082528120 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704184401 | MI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1356371777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 W BROADWAY ST",
"address_2": "SUITE A",
"city": "MT PLEASANT",
"state": "MI",
"postal_code": "488582446",
"telephone_number": "989-772-9523",
"fax_number": "989-772-9052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 W BROADWAY ST",
"address_2": "SUITE A",
"city": "MOUNT PLEASANT",
"state": "MI",
"postal_code": "488582402",
"telephone_number": "989-772-9523",
"fax_number": "989-772-9052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEMPLEMAN",
"first_name": "MICKKI",
"middle_name": "RENAE",
"credential": "CFNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704184401",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP COMMERCIAL",
"identifier": "200000004572",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4520134-11",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN",
"identifier": "1010137",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "5008701250",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.