Individual provider Active NPI

Joy Mae Mendenhall, PNP

  • Pediatric Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1841369931
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP0139 Issued in AZ
Practice address
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone
(602) 263-1511
Fax
(602) 263-1619
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN041430 AZ
Pediatric Nurse Practitioner 363LP0200X AP0139 AZ Primary

Addresses

Primary practice location

4212 N 16TH St
Phoenix, AZ 85016-5319

Mailing address

PO Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1511

Other identifiers 1

IdentifierTypeStateIssuer
463662MedicaidAZ

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

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1841369931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-0698",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100698",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1511",
            "fax_number": "602-263-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDENHALL",
        "first_name": "JOY",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "RN041430",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "AP0139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463662",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

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.

Verify at the official NPI Registry.