Active NPI
Myiesha Anderson-Moffett
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1780041590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801098986
- Practice address
- 1939 S Division Ave.
Grand Rapids, MI 49507 - Phone
- (616) 247-3815
- NPI assigned
- Jan 25, 2016
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801098986 | MI | Primary |
Addresses
Primary practice location
1939 S Division Ave.
Grand Rapids, MI 49507
Mailing address
1939 S Division Ave.
Grand Rapids, MI 49507
Phone (616) 247-3815
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 |
|---|---|---|---|
| 6801098986 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572566400000",
"number": "1780041590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1939 S DIVISION AVE.",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49507",
"telephone_number": "616-247-3815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1939 S DIVISION AVE.",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49507",
"telephone_number": "616-247-3815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON-MOFFETT",
"first_name": "MYIESHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-25",
"last_updated": "2019-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801098986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.