Stephanie Heaton Anderson, PNP, DNP, RNCS

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN173488 Issued in GA

Practice address

391 East Main Street
1 Historic Hawkins Building
Canton, GA 30114-2712

Phone

(770) 720-6963

Fax

(770) 720-6965

NPI assigned

May 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mountainside Pediatrics

  • Primary Care Clinic/Center
  • Jasper, GA
  • NPI 1710267505
  NPD (past)

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1609087972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 EAST MAIN STREET",
            "address_2": "1 HISTORIC HAWKINS BUILDING",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142712",
            "telephone_number": "770-720-6963",
            "fax_number": "770-720-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 EAST MAIN STREET",
            "address_2": "1 HISTORIC HAWKINS BUILDING",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142712",
            "telephone_number": "770-720-6963",
            "fax_number": "770-720-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "STEPHANIE",
        "middle_name": "HEATON",
        "credential": "PNP, DNP, RNCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-25",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN173488",
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "GA",
            "license": "RN173488",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN173488",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN173488",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER ID,  STEPHANIE H. ANDERSON, PNP, APRN, NPI# 1609087972",
            "identifier": "495715792A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PAYOR  ID, NORTHSIDE CHILDREN'S PEDIATRICS CTR,  NPI# 1396945515",
            "identifier": "629697125A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AUTHORIZED CONTACT REPRESENTATIVE: MICHAEL G. ANDERSON, MD (ATTENDING PHYSICIAN)",
            "identifier": "GA 54532",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirish Amrutia, M.D.
• Amw Enterprises LLC
• Christopher B Anderson, M.D.
• Evan Anderson
• Michael George Anderson, MD
• Tristan Hope Anderson, BCBA
• Emily Patricia Andreano
• Anesthesia Solutions of Georgia LLC
• Francely Ang, IBCLC
• Carol Posasda Angstadt, D.M.D.

• All providers in Canton, GA
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; 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.