Innovative Primary Care Clinic of Havasu PLLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

AP1654 Issued in AZ

Legal business name

INNOVATIVE PRIMARY CARE CLINIC OF HAVASU PLLC

Practice address

297 Lake Havasu Ave S
Suite 106
Lake Havasu City, AZ 86403-6526

Phone

(928) 854-7666

Fax

(928) 854-7660

NPI assigned

Aug 15, 2013

Last updated

Aug 16, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jacquelyn J. Meyer, N.P.

Title

President

Phone

(928) 854-7666

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376611200000",
    "number": "1588097349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27340",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850617340",
            "telephone_number": "602-943-9200",
            "fax_number": "602-216-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 LAKE HAVASU AVE S",
            "address_2": "SUITE 106",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036526",
            "telephone_number": "928-854-7666",
            "fax_number": "928-854-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PRIMARY CARE CLINIC OF HAVASU PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-15",
        "last_updated": "2013-08-16",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-854-7666",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "N.P."
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "AP1654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bret Donald Huxtable, PHARMD
• Florentyna Nnenne Igboanugo, PHARMD
• Roxana Imanian, DMD
• Innovative Health and Wellness Center
• Innovative Health Care of Havasu LLC
• Innovative Primary Care of Havasu LLC (Innovative Primary Care Clinic of Havasu)
• Innovative Primary Care of Lake Havasu LLC
• Innovative Womens Health Care of Havasu PLLC
• Institute for Male Health&Performance LLC
• Integrated Wellness Club

• Primary Care Nurse Practitioner in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Primary Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.