Dan Nurse Practitioner Services, LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

AP1489 Issued in AZ

Legal business name

DAN NURSE PRACTITIONER SERVICES, LLC

Practice address

200 W Frontier St
Suite M
Payson, AZ 85541-5362

Phone

(928) 595-1176

Fax

(928) 478-6206

NPI assigned

Jan 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deborah Ann Nichols, FNPNPI 1962425389

Title

Principal Officer

Phone

(928) 595-1176

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deborah Ann Nichols, FNP

  • Family Nurse Practitioner
  • Payson, AZ
  • NPI 1962425389

  AZ

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1295049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391472000000",
    "number": "1477858801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W. FRONTIER",
            "address_2": "SUITE M",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855417443",
            "telephone_number": "928-595-1176",
            "fax_number": "928-478-6206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W FRONTIER ST",
            "address_2": "SUITE M",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415362",
            "telephone_number": "928-595-1176",
            "fax_number": "928-478-6206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAN NURSE PRACTITIONER SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-15",
        "last_updated": "2014-02-04",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRINCIPAL OFFICER",
        "authorized_official_telephone_number": "928-595-1176",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "AP1489",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AP1489",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "AP1489",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "AP1489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID NUMBER",
            "identifier": "70871",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Payson, AZ
• Primary Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.