STEPHANIE HEATON ANDERSON (NPI# 1609087972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609087972 |
| Entity Type | Individual |
| Full Name | STEPHANIE HEATON ANDERSON |
| Credential | PNP, DNP, RNCS |
| Practice Address |
391 East Main Street 1 Historic Hawkins Building Canton GA 30114-2712 |
| Practice Telephone | 7707206963 |
| Practice Fax Number | 7707206965 |
| Mailing Telephone | 7707206963 |
| Mailing Fax Number | 7707206965 |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2011-10-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN173488 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN173488 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
RN173488 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
RN173488 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | AUTHORIZED CONTACT REPRESENTATIVE: MICHAEL G. ANDERSON, MD (ATTE | GA 54532 | 01 |
| GA | MEDICAID PAYOR ID, NORTHSIDE CHILDREN'S PEDIATRICS CTR, NPI# 139 | 629697125A | 01 |
| GA | MEDICAID PROVIDER ID, STEPHANIE H. ANDERSON, PNP, APRN, NPI# 160 | 495715792A | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982228961 | Stephanie Ellen Anderson | Speech-Language Pathologist | 401 Se Main St Apt 7011, Minneapolis, MN 55414-4618 | 2020-06-04 |
| 1902305139 | Stephanie Lee Anderson | Case Manager/Care Coordinator | 15599 E 78th St N, Owasso, OK 74055-6036 | 2018-02-02 |
| 1609321876 | Stephanie Anderson | Physical Therapist | 1940 Griggs St Se, Grand Rapids, MI 49506-4664 | 2016-08-17 |
| 1962860296 | Stephanie Anderson | Massage Therapist | 1023 Pensacola St Ste C, Honolulu, HI 96814-1957 | 2016-02-01 |
| 1386021335 | Stephanie Anderson | Social Worker | 424 Doe Lane, Lakemoor, IL 60051 | 2015-04-29 |
| 1396136586 | Stephanie Lee Anderson | Doula | 22818 Provincial Blvd, Katy, TX 77450-1632 | 2015-02-10 |
| 1114346996 | Stephanie Anderson | Speech-Language Pathologist | 12823 S 45th Pl, Phoenix, AZ 85044-4036 | 2014-04-09 |
| 1285997437 | Stephanie S. Anderson | Specialist | 480 Charles Ln, Wantagh, NY 11793-1408 | 2012-06-22 |
| 1639478704 | Stephanie Lynn Anderson | Durable Medical Equipment & Medical Supplies | 3800 Nw Loop 410, Suite 103, San Antonio, TX 78229-3618 | 2011-03-15 |
| 1467750463 | Stephanie S Anderson | Chiropractor | 1549 Fort Harrison Rd, Terre Haute, IN 47804-1332 | 2011-03-01 |
| Street Address |
391 EAST MAIN STREET 1 HISTORIC HAWKINS BUILDING |
| City | CANTON |
| State | GA |
| Zip Code | 30114-2712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073685418 | Michael George Anderson | Pediatrics | 391 East Main Street, Historic Hawkins Building, Canton, GA 30114-2712 | 2006-11-14 |
| 1396945515 | Northside Children's Pediatric Center, LLC | Clinic/Center | 391 East Main Street, Historic Hawkins Building, Canton, GA 30114-2712 | 2007-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619516093 | Wickshire Canton Opco LLC | Assisted Living Facility | 125 Riverstone Terrace, Canton, GA 30114 | 2020-01-02 |
| 1154803583 | Alixandra Nicole Flournoy | Physical Therapist | 131 Holly Street, Canton, GA 30114 | 2018-09-01 |
| 1588157341 | Provident Group - Canton Cove Properties LLC | Alzheimer Center (Dementia Center) | 1100 Reinhardt College Parkway, Canton, GA 30114 | 2018-06-07 |
| 1003233107 | Heartland Dental Care of Georgia | Dentist | 3237 Sixes Rd, Canton, GA 30114 | 2014-03-26 |
| 1730510959 | Joseph Optical | Eyewear Supplier (Equipment, not the service) | 1455 Riverstone Pkwy Suite 110, Canton, GA 30114 | 2013-12-13 |
| 1629313036 | Ramona Morton Rasmussen | Occupational Therapist | 200 Riverstone Drive, Suite B, Canton, GA 30114 | 2012-12-11 |
| 1902154875 | Yong Qiao Luo | Acupuncturist | 200 Oakside Lane, Suite D, Canton, GA 30114 | 2012-08-26 |
| 1215294350 | Christina Lynn Hernandez | Pediatrics | 1558 Riverstone Pkwy Ste 100, Canton, GA 30114 | 2012-04-13 |
| 1558638981 | Stephen E Byrd | Counselor | 191 Lamar Haley Pkwy., Canton, GA 30114 | 2011-11-30 |
| 1073807855 | Sheri Sullins Buckley | Nurse Practitioner | 120 Oakside Ct Ste H, Canton, GA 30114 | 2011-06-08 |
| Find all providers in zip 30114 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306388715 | Kelly Sarah Spooner | Nurse Practitioner | 1600 S Canton Center Rd Ste 200, Canton, MI 48188 | 2016-11-16 |
| 1750646279 | Lacy D Burkes | Nurse Practitioner | 205 W Tyler St, Canton, TX 75103-1352 | 2012-07-10 |
| 1750413696 | Patricia Ann Miller | Nurse Practitioner | 4641 Fulton Dr. Nw, Canton, OH 44718 | 2007-03-09 |
| 1780784850 | Kerry Anne Swanton | Nurse Practitioner | 49650 Cherry Hill Rd Ste 210, Canton, MI 48187-4859 | 2006-09-25 |
| 1114494002 | Emily L Koelsch | Nurse Practitioner | 3 Randolph St, Canton, MA 02021-2351 | 2018-10-29 |
| 1487980124 | Julie Slotnick | Nurse Practitioner | 3 Randolph St, Canton, MA 02021-2351 | 2009-11-01 |
| 1881887982 | Karen Wheeler Madden | Nurse Practitioner | 3 Randolph St, Canton, MA 02021-2351 | 2007-08-22 |
| 1043310618 | Patricia Reckling | Nurse Practitioner | 49650 Cherry Hill Rd, Suite 210, Canton, MI 48187-4849 | 2006-09-24 |
| 1013015155 | Wendy Storey | Nurse Practitioner | 49650 Cherry Hill Rd, Suite 210, Canton, MI 48187-4849 | 2006-09-20 |
| 1386742427 | Bryn Gerich Vi | Nurse Practitioner | 49650 Cherry Hill Rd, Suite 210, Canton, MI 48187-4849 | 2006-09-20 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.