Active NPI
Myra Lee Popernack, CRNP
- Pediatric Nurse Practitioner
- Hershey, PA
National Provider Identifier
1376863555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- SP010470
- Practice address
- 500 University Dr
Hershey, PA 17033-2360 - Phone
- (800) 243-1455
- NPI assigned
- Jun 10, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| SP010470 | PA | MD | Pediatric Nurse Practitioner |
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 | SP010470 | PA | Primary |
Addresses
Primary practice location
500 University Dr
Hershey, PA 17033-2360
Mailing address
500 University Dr
Hershey, PA 17033-2360
Phone (800) 243-1455
NPI Registry JSON
{
"created_epoch": "1276128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276128000000",
"number": "1376863555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 UNIVERSITY DR",
"city": "HERSHEY",
"state": "PA",
"postal_code": "170332360",
"telephone_number": "800-243-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 UNIVERSITY DR",
"city": "HERSHEY",
"state": "PA",
"postal_code": "170332360",
"telephone_number": "800-243-1455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POPERNACK",
"first_name": "MYRA",
"middle_name": "LEE",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-10",
"last_updated": "2010-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "PA",
"license": "SP010470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hershey, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.