Active NPI
Ryan Havens, AGPCNP-BC
- Gerontology Nurse Practitioner
- Royal Oak, MI
National Provider Identifier
1629473228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 4704230300
- Practice address
- 3601 W 13 Mile Rd
Royal Oak, MI 48073-6712 - Phone
- (248) 898-4021
- Fax
- (248) 898-1473
- NPI assigned
- Oct 27, 2014
- Last updated
- Nov 4, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 4704230300 | MI | |
| Gerontology Nurse Practitioner | 363LG0600X | 4704230300 | MI | Primary |
| Nurse Practitioner | 363L00000X | 4704230300 | MI |
Addresses
Primary practice location
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Mailing address
26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849
Other practice location 1
4600 Investment Dr
Suite 200
Troy, MI 48098-6365
Phone (248) 267-5050
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rhavens19520@direct.beaumont.edu |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704230300 | MI | MD | Primary Care Nurse Practitioner |
Interoperability endpoints
- rhavens19520@direct.beaumont.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1629473228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26901 BEAUMONT BLVD STE 3D",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 W 13 MILE RD",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480736712",
"telephone_number": "248-898-4021",
"fax_number": "248-898-1473"
}
],
"practiceLocations": [
{
"address_1": "4600 Investment Dr",
"address_2": "Suite 200",
"address_purpose": "LOCATION",
"city": "Troy",
"state": "MI",
"postal_code": "480986365",
"country_code": "US",
"telephone_number": "248-267-5050",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HAVENS",
"first_name": "RYAN",
"credential": "AGPCNP-BC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-27",
"last_updated": "2021-11-04",
"certification_date": "2021-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "MI",
"license": "4704230300",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MI",
"license": "4704230300",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704230300",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rhavens19520@direct.beaumont.edu",
"affiliation": "N",
"address_1": "3601 W 13 Mile Rd",
"city": "Royal Oak",
"state": "MI",
"country_code": "US",
"postal_code": "480736712",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.