(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Nurse Practitioner | 363L00000X |
| Acute Care | 363LA2100X | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
* Indicates primary specialty
| NPI Number | 1104569201 |
| Credentials | NP (Nurse Practitioner) |
| Entity | Individual |
| Enumeration date | 04/16/2022 |
| Last updated | 04/22/2025 - More than a year ago |
| Sole proprietor1 | No |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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