Active NPI
Makenson Geffrard
- Psychiatric/Mental Health Nurse Practitioner
- Port Saint Lucie, FL
National Provider Identifier
1396478897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 11020573
- Practice address
- 4118 SW Utterback St
Port Saint Lucie, FL 34953-6100 - Phone
- (772) 607-0492
- NPI assigned
- Jul 3, 2022
- Last updated
- Jul 3, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 11020573 | FL | Primary |
Addresses
Primary practice location
4118 SW Utterback St
Port Saint Lucie, FL 34953-6100
Mailing address
4118 SW Utterback St
Port Saint Lucie, FL 34953-6100
Phone (772) 607-0492
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 |
|---|---|---|---|
| 11020573 | FL | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656806400000",
"number": "1396478897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4118 SW UTTERBACK ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349536100",
"telephone_number": "772-607-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4118 SW UTTERBACK ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349536100",
"telephone_number": "772-607-0492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEFFRARD",
"first_name": "MAKENSON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-03",
"last_updated": "2022-07-03",
"certification_date": "2022-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "FL",
"license": "11020573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.