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NORTHRIDGE FAMILY PRACTICE LLC
NPI 1891712493
Nurse Practitioner in Hale, MI

Active since July 17, 2006
3190 NORTHRIDGE DRIVE, HALE, MI 48739(989) 728-6000(989) 728-6003 Get Directions Write a Review

NPPES record last updated: November 2, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Northridge Family Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHRIDGE FAMILY PRACTICE LLC (NPI 1891712493) is a healthcare organization registered as a nurse practitioner in Hale, Michigan and active in the NPI registry since July 2006. The organization lists Debra Kaye Provoast, Managing Officer, as its authorized official.

NPPES Registry Identity

NPI1891712493
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameNORTHRIDGE FAMILY PRACTICE LLC
Location Address3190 NORTHRIDGE DRIVEHale, MI 48739-9276
Mailing AddressPo Box 279Hale, MI 48739-0279 · (989) 728-6000 · Fax (989) 728-6003
Phone(989) 728-6000
Fax(989) 728-6003
Organization SubpartNo
Authorized OfficialDebra Kaye ProvoastManaging Officer · (989) 728-6000
Enumeration DateJuly 17, 2006
Last NPPES UpdateNovember 2, 2015
✔ NPI 1891712493 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Licenses✔ Licensed in MI · 4704173663✔ Licensed in MI · 4704148660
Definition
(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.
Also ListedInternal MedicineTaxonomy 207R00000X · License 4301061417 (MI)
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 4704245250 (MI), 4704283185 (MI)
3190 NORTHRIDGE DRIVE, Hale, MI 48739
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Other Identifiers 19

OtherMA061417Mohamed Ali
OtherRAILROAD MEDICAREMI · P00261196
Other1017859MI · Mclaren
OtherBW148660MI · Beth Weaver License
Medicaid105235126MI
Medicaid105230710MI
Medicare ID-Type UnspecifiedOP24490002Beath Weaver
Medicaid104289418MI
OtherOC51020Blue Cross Blue Shield
OtherDD9334MI · Railroad Medicare
Other4704283185MI · Lindsey License
Medicare PIN0P24490004MI
Other=========102MI · Ccm Debbie Provoast
Medicare ID-Type Unspecified0P24490MI · Medicare Group
Medicare ID-Type UnspecifiedOP24490001
OtherDP173663MI · Debbie Provoast License
Other=========101MI · Ccm Beth Weaver
Other1017858MI · Mclaren Deb Provoast
Medicare PIN0P24490001MI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEBRA K PROVOAST NP
Nurse Practitioner (Family)
3190 NORTHRIDGE DRIVE
HALE, MI 48739
Iosco County (989) 728-6000
BETH A WEAVER NP
Nurse Practitioner (Family)
3190 NORTHRIDGE DRIVE
HALE, MI 48739
Iosco County (989) 728-6000
NORTHRIDGE FAMILY PRACTICE LLC
Internal Medicine (Clinical Cardiac Electrophysiology)
3190 NORTHRIDGE DRIVE
HALE, MI 48739
Iosco County (989) 728-6000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northridge Family Practice LLC's NPI number?

The NPI number for Northridge Family Practice LLC is 1891712493. It was assigned to this organization in the NPPES registry on July 17, 2006.

Where is Northridge Family Practice LLC located?

Northridge Family Practice LLC is located at 3190 Northridge Drive, Hale, MI 48739. The listed phone number is (989) 728-6000.

What is Northridge Family Practice LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Northridge Family Practice LLC was last updated on November 2, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.