Andrea Graham Southerland, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4552609-4405 Issued in UT

Practice address

1420 W 12600 S Ste 102
Riverton, UT 84065-7080

Phone

(801) 254-4600

Fax

(801) 254-9670

NPI assigned

Nov 12, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• New Horizon Medical Care Inc

  • Family Medicine Physician
  • Riverton, UT
  • NPI 1912136862
  Medicare reassignment NPD

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

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1932353380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 W 12600 S STE 102",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657080",
            "telephone_number": "801-254-4600",
            "fax_number": "801-254-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 W 12600 S STE 102",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657080",
            "telephone_number": "801-254-4600",
            "fax_number": "801-254-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHERLAND",
        "first_name": "ANDREA",
        "middle_name": "GRAHAM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-12",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "4552609-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1932353380",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terry R. Sorenson, DMD
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• South Hills Pediatric Dentistry
• South Valley Compounding Pharmacy LLC (South Valley Compounding Pharmacy)
• Laura Southwick
• Thomas Sowers
• Breanna Spangler
• Jacob Sparks, LMFT
• Kimberly Spiva

• Family Nurse Practitioner in Riverton, UT
• Providers in Riverton, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; 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.

Verify at the official NPI Registry.