Active NPI
Amanda Mae Widener
- Community Health Worker
- Olivehurst, CA
National Provider Identifier
1659838522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 1816 8TH Ave
Olivehurst, CA 95961-4305 - Phone
- (405) 489-2179
- NPI assigned
- Feb 26, 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CA | ||
| Professional Counselor | 101YP2500X | CA | ||
| Basic Emergency Medical Technician | 146N00000X | CA | ||
| Case Manager/Care Coordinator | 171M00000X | CA | ||
| Driver | 172A00000X | CA | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | ||
| Community Health Worker | 172V00000X | CA | Primary |
Addresses
Primary practice location
1816 8TH Ave
Olivehurst, CA 95961-4305
Mailing address
1816 8TH Ave
Olivehurst, CA 95961-4305
Phone (405) 489-2179
Other practice location 1
5620 Arboga Road
Olivehurst, CA 95961-9596
Phone (405) 489-2179
Other practice location 2
230 E St # 203
Marysville, CA 95901-5923
Phone (405) 489-2179
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116993628 | Other | CA | DUNS |
| 1659838522 | Medicaid | CA |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Corporate.2019AR@gmail.com | Health Information Exchange (HIE) | |
| Other URL | Corporate.2019AR@gmail.com | Health Information Exchange (HIE) |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1659838522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1816 8TH AVE",
"city": "OLIVEHURST",
"state": "CA",
"postal_code": "959614305",
"telephone_number": "405-489-2179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1816 8TH AVE",
"city": "OLIVEHURST",
"state": "CA",
"postal_code": "959614305",
"telephone_number": "405-489-2179"
}
],
"practiceLocations": [
{
"address_1": "5620 Arboga Road",
"address_purpose": "LOCATION",
"city": "Olivehurst",
"state": "CA",
"postal_code": "959619596",
"country_code": "US",
"telephone_number": "405-489-2179",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "230 E St # 203",
"address_purpose": "LOCATION",
"city": "Marysville",
"state": "CA",
"postal_code": "959015923",
"country_code": "US",
"telephone_number": "405-489-2179",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIDENER",
"first_name": "AMANDA",
"middle_name": "MAE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-26",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DUNS",
"identifier": "116993628",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1659838522",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Corporate.2019AR@gmail.com",
"affiliation": "N",
"endpointDescription": "Business Email Address",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Health Information Exchange",
"address_1": "230 E St # 203",
"city": "Marysville",
"state": "CA",
"country_code": "US",
"postal_code": "959015923",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Corporate.2019AR@gmail.com",
"affiliation": "N",
"endpointDescription": "Business Email Address",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Health Information Exchange",
"address_1": "1816 8th Ave",
"city": "Olivehurst",
"state": "CA",
"country_code": "US",
"postal_code": "959614305",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Olivehurst, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.