Active NPI
Jennifer Rebekah Larson, PHD
- Clinical Neuropsychologist
- Raleigh, NC
National Provider Identifier
1487665584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 2648
- Practice address
- 8406 Six Forks Rd Ste 101
Raleigh, NC 27615-3075 - Phone
- (919) 473-6451
- Fax
- (844) 584-4207
- NPI assigned
- Aug 11, 2006
- Last updated
- Oct 15, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 2648 | NC | Primary |
| Clinical Psychologist | 103TC0700X | 2648 | NC |
Addresses
Primary practice location
8406 Six Forks Rd Ste 101
Raleigh, NC 27615-3075
Mailing address
8406 Six Forks Rd Ste 101
Raleigh, NC 27615-3075
Phone (919) 473-6451
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000216 | Medicaid | NC | |
| 045GA | Other | NC | BCBS |
Other names 1
- Jennifer Rebekah Hiemenz
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2648 | NC | MD | Optometrist |
Interoperability endpoints
- jennifer.hiemenz@direct.jlp.nchie.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571097600000",
"number": "1487665584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8406 SIX FORKS RD STE 101",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153075",
"telephone_number": "919-473-6451",
"fax_number": "844-584-4207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8406 SIX FORKS RD STE 101",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153075",
"telephone_number": "919-473-6451",
"fax_number": "844-584-4207"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JENNIFER",
"middle_name": "REBEKAH",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-11",
"last_updated": "2019-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NC",
"license": "2648",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "2648",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000216",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "045GA",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "HIEMENZ",
"middle_name": "REBEKAH",
"credential": "PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.