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NPI Code Detail

MEDICARE: AMY HETHERINGTON NP

MEDICARE: AMY HETHERINGTON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner95004923CA

General Provider Information

NPI Number : 1639628001
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY HETHERINGTON NP
Provider Business Mailing Address
First Line : 39000 BOB HOPE DR
Second Line :
City : RANCHO MIRAGE
State : CA
Zip : 92270-3202
Country : US
Telephone Number : 760-340-3911
Fax Number : 760-773-1448
Provider Business Practice Location Address
First Line : 39000 BOB HOPE DR
Second Line :
City : RANCHO MIRAGE
State : CA
Zip : 92270-3202
Country : US
Telephone Number : 760-340-3911
Fax Number : 760-773-1448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2016
Last Update Date : 05/20/2026

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