Active NPI
Mary Louise Grant, NP-F
- Family Nurse Practitioner
- Yucca Valley, CA
National Provider Identifier
1891831582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 13944
- Practice address
- 55585 29 Palms Hwy
Yucca Valley, CA 92284-2505 - Phone
- (760) 228-3366
- Fax
- (760) 228-3369
- NPI assigned
- Jan 29, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 13944 | CA | Primary |
Addresses
Primary practice location
55585 29 Palms Hwy
Yucca Valley, CA 92284-2505
Mailing address
55585 29 Palms Hwy
Yucca Valley, CA 92284-2505
Phone (760) 228-3366
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450731 | Other | CA | RN LICENSE # |
| 13944 | Other | CA | NP LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sac Health System | Current | Accepting new patients |
Interoperability endpoints
- mgrant139093@direct.llu.edu
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 and National Provider Directory roles.
-
- Family Medicine Physician
- San Bernardino, CA
- NPI 1043721939
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1891831582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55585 29 PALMS HWY",
"city": "YUCCA VALLEY",
"state": "CA",
"postal_code": "922842505",
"telephone_number": "760-228-3366",
"fax_number": "760-228-3369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55585 29 PALMS HWY",
"city": "YUCCA VALLEY",
"state": "CA",
"postal_code": "922842505",
"telephone_number": "760-228-3366",
"fax_number": "760-228-3369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "MARY",
"middle_name": "LOUISE",
"credential": "NP-F",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "13944",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE #",
"identifier": "450731",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NP LICENSE #",
"identifier": "13944",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yucca Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.