Active NPI
Tara Jo Dekamp, CPNP-PC
- Pediatric Nurse Practitioner
- Hanover, MI
National Provider Identifier
1740958933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 4704304674
- Practice address
- 7999 Folks Rd
Hanover, MI 49241-9784 - Phone
- (517) 250-0800
- NPI assigned
- Sep 1, 2021
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704304674 | MI | Primary |
Addresses
Primary practice location
7999 Folks Rd
Hanover, MI 49241-9784
Mailing address
7999 Folks Rd
Hanover, MI 49241-9784
Phone (517) 250-0800
Other practice location 1
601 John St Ste M-351
Kalamazoo, MI 49007-5358
Phone (269) 341-8986
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | direct@direct.bronsonhg.org | Direct | Bronson HealthCare Group |
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 |
|---|---|---|---|
| 4704304674 | MI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655856000000",
"number": "1740958933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7999 FOLKS RD",
"city": "HANOVER",
"state": "MI",
"postal_code": "492419784",
"telephone_number": "517-250-0800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7999 FOLKS RD",
"city": "HANOVER",
"state": "MI",
"postal_code": "492419784",
"telephone_number": "517-250-0800"
}
],
"practiceLocations": [
{
"address_1": "601 John St Ste M-351",
"address_purpose": "LOCATION",
"city": "Kalamazoo",
"state": "MI",
"postal_code": "490075358",
"country_code": "US",
"telephone_number": "269-341-8986",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEKAMP",
"first_name": "TARA",
"middle_name": "JO",
"credential": "CPNP-PC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-01",
"last_updated": "2022-06-22",
"certification_date": "2022-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MI",
"license": "4704304674",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "direct@direct.bronsonhg.org",
"affiliation": "Y",
"endpointDescription": "Bronson HealthCare Group Direct Address",
"affiliationName": "Bronson HealthCare Group",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Continuity of Care Document",
"address_1": "601 John St",
"city": "Kalamazoo",
"state": "MI",
"country_code": "US",
"postal_code": "490075341",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Hanover, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.