Active NPI
Daphne Dawn Thivener
- Licensed Practical Nurse
- Groveport, OH
National Provider Identifier
1710190624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN 095202
- Practice address
- 4830 Elmont PL
Groveport, OH 43125-9646 - Phone
- (614) 679-6300
- NPI assigned
- May 7, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN 095202 | OH | Primary |
Addresses
Primary practice location
4830 Elmont PL
Groveport, OH 43125-9646
Mailing address
4830 Elmont PL
Groveport, OH 43125-9646
Phone (614) 679-6300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2200371 | Medicaid | OH |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN 095202 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1710190624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4830 ELMONT PL",
"city": "GROVEPORT",
"state": "OH",
"postal_code": "431259646",
"telephone_number": "614-679-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4830 ELMONT PL",
"city": "GROVEPORT",
"state": "OH",
"postal_code": "431259646",
"telephone_number": "614-679-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIVENER",
"first_name": "DAPHNE",
"middle_name": "DAWN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN 095202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2200371",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Groveport, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.