Keoviengkhone Merina Hakvongsa, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704212195 Issued in MI

Practice address

22201 Moross Rd
Suite 150
Detroit, MI 48236-2169

Phone

(586) 247-4300

Fax

(586) 532-6496

NPI assigned

Sep 21, 2006

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 names 1

• Keoviengkhone Merina Latimer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Central Michigan Osteoporosis Treatment Center, PLC

  • Hematology & Oncology Physician
  • Saint Johns, MI
  • NPI 1013022086
  NPD (past)
• Colorado Springs Nephrology

  • Nephrology Physician
  • Colorado Springs, CO
  • NPI 1376879254
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1992804660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45640 SCHOENHERR RD",
            "address_2": "SUITE B",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156033",
            "telephone_number": "586-247-4300",
            "fax_number": "586-532-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22201 MOROSS RD",
            "address_2": "SUITE 150",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362169",
            "telephone_number": "586-247-4300",
            "fax_number": "586-532-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAKVONGSA",
        "first_name": "KEOVIENGKHONE",
        "middle_name": "MERINA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704212195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEOVIENGKHONE",
            "last_name": "LATIMER",
            "middle_name": "MERINA",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Arif Husain Hakim, M.D.
• Cindy Hakim, MD
• Kaitlyn Hakim
• Mary Katta Hakim, M.D.
• Zaher Hakim, M.D
• Amber Leigh Hal
• Mouhammad Halabi
• Saleem M Halablab, MD
• Adnan Marwan Mohd Halboni, MD
• Barbara Jean Hale

• Family Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; 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.