Rachel Anne Prudhomme, DNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704309686 Issued in MI

Practice address

2730 5 Mile Rd NE
Grand Rapids, MI 49525-6518

Phone

(616) 426-9401

NPI assigned

Feb 9, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eagle Village Inc

  • Psychiatric Residential Treatment Facility
  • Hersey, MI
  • NPI 1710351598
  Medicare reassignment NPD
• Physician Universe, PLLC

  • Specialist
  • Bloomfield Hills, MI
  • NPI 1023435856
  Medicare reassignment NPD
• Innovation Medicine, PLLC

  • Internal Medicine Physician
  • Roseville, MI
  • NPI 1720511405
  NPD (past)

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

{
    "created_epoch": "1423440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1487045753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22234 220TH AVE",
            "city": "PARIS",
            "state": "MI",
            "postal_code": "493389455",
            "telephone_number": "231-742-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 5 MILE RD NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256518",
            "telephone_number": "616-426-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDHOMME",
        "first_name": "RACHEL",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-09",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704309686",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704309686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proof We Exist Therapist
• Karin Proos, PHARMD
• Kimberlee Jean Prose, PSY.D.
• Tammy Lynn Provatas, M.D.
• Prudentia Counseling and Consulting, LLC
• Holly Jo Pruett, COTA
• Amber Pruitt
• Brooklyn Joyce Pruitt
• Markia Pruitt
• Misty Chanel Pruitt, LLMSW

• Psychiatric/Mental Health Nurse Practitioner in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.

Verify at the official NPI Registry.