Individual provider Active NPI

Juliet Karen Hegdal, FNP

  • Family Nurse Practitioner
  • Redway, CA
National Provider Identifier
1790964336
Registry record updated May 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
17324 Issued in CA
Practice address
101 West Coast Rd.
Redway, CA 95560-0769
Phone
(707) 923-2783
Fax
(707) 923-2543
NPI assigned
Oct 31, 2007
Last updated
May 12, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 17324 CA Primary

Addresses

Primary practice location

101 West Coast Rd.
Redway, CA 95560-0769

Mailing address

PO Box 769
Redway, CA 95560-0769
Phone (707) 923-2783

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161012002203 CA Order and Referring Only - Nurse Practitioner 3476622432

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
17324CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Varun Gupta MD Professional Corporation PastSince Feb 19, 2014 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: juliet.hegdal.p1@direct.rrhc.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1790964336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 769",
            "city": "REDWAY",
            "state": "CA",
            "postal_code": "955600769",
            "telephone_number": "707-923-2783",
            "fax_number": "707-923-2543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WEST COAST RD.",
            "city": "REDWAY",
            "state": "CA",
            "postal_code": "955600769",
            "telephone_number": "707-923-2783",
            "fax_number": "707-923-2543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEGDAL",
        "first_name": "JULIET",
        "middle_name": "KAREN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "17324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redway, CA

Sources for this page

Verify at the official NPI Registry.