Active NPI
Rose A Hettinga, APN
- Family Medicine Physician
- Henderson, NV
National Provider Identifier
1912965278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 000582
- Practice address
- 600 Whitney Ranch Dr
B6
Henderson, NV 89014-2611 - Phone
- (702) 547-0088
- Fax
- (702) 434-1579
- NPI assigned
- May 3, 2006
- 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 Medicine Physician | 207Q00000X | 000582 | NV | Primary |
Addresses
Primary practice location
600 Whitney Ranch Dr
B6
Henderson, NV 89014-2611
Mailing address
2300 Corporate Cir
190
Henderson, NV 89074-7724
Phone (702) 932-8547
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00367731 | Other | NV | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| 000582 | NV | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Diagnostic Service | Past | Accepting new patients | |
| Healthcare Partners Medical Group (Coats), LTD. | Past | Accepting new patients |
Organizations & group practices 2
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.
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- NPI 1235344516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193097600000",
"number": "1912965278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 CORPORATE CIR",
"address_2": "190",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890747724",
"telephone_number": "702-932-8547",
"fax_number": "702-932-8587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 WHITNEY RANCH DR",
"address_2": "B6",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890142611",
"telephone_number": "702-547-0088",
"fax_number": "702-434-1579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETTINGA",
"first_name": "ROSE",
"middle_name": "A",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2007-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NV",
"license": "000582",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00367731",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.