Active NPI
Dericka Webster, LPN
- Nursing Care Agency
- Atlanta, GA
National Provider Identifier
1720570849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Care Agency
- License
- LPN080024
- Practice address
- 4690 Greenleaf Cir SW
Atlanta, GA 30331-7142 - Phone
- (167) 843-7061
- NPI assigned
- Jun 4, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | LPN080024 | GA | Primary |
Addresses
Primary practice location
4690 Greenleaf Cir SW
Atlanta, GA 30331-7142
Mailing address
4690 Greenleaf Cir SW
Atlanta, GA 30331-7142
Phone (167) 843-7061
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPN080024 | Other | GA | LPN |
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 |
|---|---|---|---|
| LPN080024 | GA | MD | Nursing Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528070400000",
"number": "1720570849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4690 GREENLEAF CIR SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303317142",
"telephone_number": "167-843-7061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4690 GREENLEAF CIR SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303317142",
"telephone_number": "167-843-7061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEBSTER",
"first_name": "DERICKA",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-04",
"last_updated": "2018-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": "GA",
"license": "LPN080024",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPN",
"identifier": "LPN080024",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.