Active NPI
Amanda Cavanaugh
- Neonatal Nurse Practitioner
- Traverse City, MI
National Provider Identifier
1588032775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal Nurse Practitioner
- License
- 904262
- Practice address
- 1105 Sixth St
Traverse City, MI 49684 - Phone
- (231) 935-6250
- NPI assigned
- Sep 4, 2015
- Last updated
- Oct 31, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neonatal Intensive Care Registered Nurse | 163WN0002X | 1-115133 | AL | |
| Neonatal Nurse Practitioner | 363LN0000X | 904262 | MS | Primary |
Addresses
Primary practice location
1105 Sixth St
Traverse City, MI 49684
Mailing address
1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5000
Other practice location 1
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-1000
Other practice location 2
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00102370 | Medicaid | MS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-115133 | AL | MD | Neonatal Intensive Care Registered Nurse |
| 904262 | MS | MD | Family Nurse Practitioner |
Interoperability endpoints
- acavanaugh561027@direct.healthsystem.virginia.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572480000000",
"number": "1588032775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842345",
"telephone_number": "231-935-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "49684",
"telephone_number": "231-935-6250"
}
],
"practiceLocations": [
{
"address_1": "2500 N State St",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MS",
"postal_code": "392164500",
"country_code": "US",
"telephone_number": "601-984-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2500 N State St",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MS",
"postal_code": "392164500",
"country_code": "US",
"telephone_number": "601-984-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CAVANAUGH",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-04",
"last_updated": "2019-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "163WN0002X",
"taxonomy_group": "",
"desc": "Registered Nurse, Neonatal Intensive Care",
"state": "AL",
"license": "1-115133",
"primary": false
},
{
"code": "363LN0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Neonatal",
"state": "MS",
"license": "904262",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00102370",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.