Active NPI
Heather Michelle Moon, LPN
- Licensed Practical Nurse
- Franklin, OH
National Provider Identifier
1417220153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN104587
- Practice address
- 5091 Todd Rd
Franklin, OH 45005-5076 - Phone
- (937) 790-6577
- NPI assigned
- Feb 10, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN104587 | OH | Primary |
Addresses
Primary practice location
5091 Todd Rd
Franklin, OH 45005-5076
Mailing address
5091 Todd Rd
Franklin, OH 45005-5076
Phone (937) 790-6577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PN104587 | Other | OH | BOARD OF NURSING |
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 |
|---|---|---|---|
| PN104587 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328832000000",
"number": "1417220153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5091 TODD RD",
"city": "FRANKLIN",
"state": "OH",
"postal_code": "450055076",
"telephone_number": "937-790-6577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5091 TODD RD",
"city": "FRANKLIN",
"state": "OH",
"postal_code": "450055076",
"telephone_number": "937-790-6577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "HEATHER",
"middle_name": "MICHELLE",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-10",
"last_updated": "2012-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN104587",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF NURSING",
"identifier": "PN104587",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Franklin, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.