Individual provider Active NPI

Valencia Carol Fleming, FNP

  • Nurse Practitioner
  • Cypress, CA
National Provider Identifier
1629023932
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN 91955 Issued in TN
Practice address
5757 Plaza Drvie
Cypress, CA 90630-5000
Phone
(770) 324-3692
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN 91955 TN Primary

Addresses

Primary practice location

5757 Plaza Drvie
Cypress, CA 90630-5000

Mailing address

518 Cobblestone Creek CT
Mableton, GA 30126-2657
Phone (901) 828-2077

Other practice location 1

9900 Bren Rd E
Minnetonka, MN 55343-9664
Phone (770) 324-3692

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040621000335 TN Practitioner - Nurse Practitioner 5597740035

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6667TNMDOccupational Therapist
RN 91955TNMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1629023932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 COBBLESTONE CREEK CT",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301262657",
            "telephone_number": "901-828-2077",
            "fax_number": "770-970-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 PLAZA DRVIE",
            "city": "CYPRESS",
            "state": "CA",
            "postal_code": "906305000",
            "telephone_number": "770-324-3692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9900 Bren Rd E",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553439664",
            "country_code": "US",
            "telephone_number": "770-324-3692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLEMING",
        "first_name": "VALENCIA",
        "middle_name": "CAROL",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "RN 91955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cypress, CA

Sources for this page

Verify at the official NPI Registry.