Oak Street Health Of Texas, Pllc | |
4115 E Lancaster Ave Fort Worth TX 76103-3614 | |
(312) 733-9730 | |
Not Available |
Full Name | Oak Street Health Of Texas, Pllc |
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Speciality | Clinic/Center |
Location | 4115 E Lancaster Ave, Fort Worth, Texas |
Authorized Official Name and Position | Griffin Myers (CMO) |
Authorized Official Contact | 3072642085 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Oak Street Health Of Texas, Pllc Po Box 746079 Atlanta GA 30374-6079 Ph: (312) 733-9730 | Oak Street Health Of Texas, Pllc 4115 E Lancaster Ave Fort Worth TX 76103-3614 Ph: (312) 733-9730 |
NPI Number | 1497387419 |
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Provider Enumeration Date | 02/07/2020 |
Last Update Date | 11/15/2023 |
Certification Date | 11/15/2023 |
Medicare PECOS PAC ID | 2163843038 |
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Medicare Enrollment ID | O20200601001767 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497387419 | NPI | - | NPPES |
Provider Name | Roy Alan Setzenfand |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1659305696 PECOS PAC ID: 1557356011 Enrollment ID: I20040714000530 |
Provider Name | Courtney M Cooner |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1174711220 PECOS PAC ID: 7810956174 Enrollment ID: I20041004000785 |
Provider Name | Marilyn Horton |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1104851906 PECOS PAC ID: 8527085745 Enrollment ID: I20051027000587 |
Provider Name | Juanita Dauya |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326065293 PECOS PAC ID: 4385743962 Enrollment ID: I20070621000720 |
Provider Name | Christopher E Berry |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1275503641 PECOS PAC ID: 4789684572 Enrollment ID: I20081010000349 |
Provider Name | Lisa F Chin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043519747 PECOS PAC ID: 3779618582 Enrollment ID: I20110628000902 |
Provider Name | Shonna L Harris |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912217167 PECOS PAC ID: 9032380837 Enrollment ID: I20110928000370 |
Provider Name | Felicia K Coleman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609132521 PECOS PAC ID: 9133381924 Enrollment ID: I20120423000755 |
Provider Name | Arun T Jacob |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1053688457 PECOS PAC ID: 7214170885 Enrollment ID: I20130829000395 |
Provider Name | James Hodges |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1659620029 PECOS PAC ID: 5395965636 Enrollment ID: I20141008001321 |
Provider Name | Lindsey N Edwards |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790176287 PECOS PAC ID: 2567789662 Enrollment ID: I20150331000420 |
Provider Name | Santa Espinoza |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447644778 PECOS PAC ID: 4981923265 Enrollment ID: I20150508000201 |
Provider Name | Jillianne A Cheong |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417334954 PECOS PAC ID: 5890006514 Enrollment ID: I20150623000604 |
Provider Name | Jean Anderson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518242064 PECOS PAC ID: 1557528817 Enrollment ID: I20151210000119 |
Provider Name | Donna K Austin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871581082 PECOS PAC ID: 6002867439 Enrollment ID: I20151228000021 |
Provider Name | Evelyn O Oshoro Akingbade |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841677671 PECOS PAC ID: 4082919352 Enrollment ID: I20160224001322 |
Provider Name | Mona Eltiar |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518414341 PECOS PAC ID: 9335420405 Enrollment ID: I20170103001745 |
Provider Name | Daniel Garcia |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578910220 PECOS PAC ID: 5991087264 Enrollment ID: I20170120001836 |
Provider Name | Lavea A Landrum |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457703779 PECOS PAC ID: 2466738919 Enrollment ID: I20170417001575 |
Provider Name | Rebecca Munzon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083159388 PECOS PAC ID: 0143507012 Enrollment ID: I20170502000333 |
Provider Name | Monnie E Adereti |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922498468 PECOS PAC ID: 7810264686 Enrollment ID: I20170526000305 |
Provider Name | Aracely Vasquez |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1720407349 PECOS PAC ID: 3072880897 Enrollment ID: I20170530000742 |
Provider Name | Sarah E. Laibstain |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598994337 PECOS PAC ID: 9830355494 Enrollment ID: I20170808001628 |
Provider Name | Corey W Henry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356403075 PECOS PAC ID: 0648530063 Enrollment ID: I20180205000020 |
Provider Name | Lashica Y Scaife |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407162407 PECOS PAC ID: 4082883012 Enrollment ID: I20180305001520 |
Provider Name | Voke Eshareturi |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598150328 PECOS PAC ID: 7911258967 Enrollment ID: I20181001003087 |
Provider Name | Marifi Guardiola |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770978736 PECOS PAC ID: 7517245566 Enrollment ID: I20181121002224 |
Provider Name | Amanda Elise Mohammed |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891172839 PECOS PAC ID: 6305180829 Enrollment ID: I20181210002101 |
Provider Name | Zenobia L Newman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730479668 PECOS PAC ID: 2264603349 Enrollment ID: I20190109001635 |
Provider Name | Jennifer Duyen Trinh |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1770943177 PECOS PAC ID: 2365776622 Enrollment ID: I20190620002691 |
Provider Name | Claude V Capistrano |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093270894 PECOS PAC ID: 1658609896 Enrollment ID: I20190826001836 |
Provider Name | Andrei G Scherer |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1841640414 PECOS PAC ID: 5092008680 Enrollment ID: I20190829000385 |
Provider Name | Delesa Gabrielle Bradley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114576881 PECOS PAC ID: 0244561439 Enrollment ID: I20191021000965 |
Provider Name | Kenya Nicole Nelson |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1265089320 PECOS PAC ID: 6608108360 Enrollment ID: I20191029003302 |
Provider Name | Shonna Harris |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477186823 PECOS PAC ID: 8729416508 Enrollment ID: I20200309002109 |
Provider Name | Kirstin Ruiz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386203842 PECOS PAC ID: 0446680953 Enrollment ID: I20200424001305 |
Provider Name | Anna Poulos |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1689121121 PECOS PAC ID: 9436438876 Enrollment ID: I20200610000993 |
Provider Name | Melissa Cruz |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1205473881 PECOS PAC ID: 2466874680 Enrollment ID: I20200617000396 |
Provider Name | Gibson Ann Hernandez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811408644 PECOS PAC ID: 0244652469 Enrollment ID: I20200617000538 |
Provider Name | Funmilayo Eniola Bola-raji |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457978272 PECOS PAC ID: 1052735024 Enrollment ID: I20200723000816 |
Provider Name | Nina Fakunle |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578111340 PECOS PAC ID: 9032538061 Enrollment ID: I20200924001937 |
Provider Name | Helen Grace Tolentino-gomintong |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194366591 PECOS PAC ID: 5193145126 Enrollment ID: I20201013002925 |
Provider Name | Jose F Collazo Colon |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1346612157 PECOS PAC ID: 0648573162 Enrollment ID: I20201216000156 |
Provider Name | Natasha Gupta |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1326492232 PECOS PAC ID: 0345532016 Enrollment ID: I20201218000119 |
Provider Name | Justin Hunt |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326138074 PECOS PAC ID: 6901842228 Enrollment ID: I20210125001312 |
Provider Name | Sonya Jefferson Joubert |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942803754 PECOS PAC ID: 4981010410 Enrollment ID: I20210309001125 |
Provider Name | Natalia Klusacek |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497142285 PECOS PAC ID: 1759686660 Enrollment ID: I20210427000464 |
Provider Name | Shannon Krop |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104393347 PECOS PAC ID: 4082956172 Enrollment ID: I20210429001975 |
Provider Name | Ashley Chou |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1033409297 PECOS PAC ID: 9234376054 Enrollment ID: I20210719000026 |
Provider Name | Fanny Lean Ho |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649774183 PECOS PAC ID: 8022362276 Enrollment ID: I20210817002629 |
Provider Name | Rachel Sabb |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1629321096 PECOS PAC ID: 0547412371 Enrollment ID: I20210818001034 |
Provider Name | Michael Azubuike Uwaelue |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992352660 PECOS PAC ID: 2668889189 Enrollment ID: I20210830000311 |
Provider Name | Francisco Espino |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902449820 PECOS PAC ID: 6406282334 Enrollment ID: I20210922001627 |
Provider Name | Christiana Beveridge |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1316441199 PECOS PAC ID: 1355748088 Enrollment ID: I20210923001215 |
Provider Name | Dongchul Paek |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1013351840 PECOS PAC ID: 7113245226 Enrollment ID: I20211012000935 |
Provider Name | Melanie Adams |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1649831298 PECOS PAC ID: 5597155788 Enrollment ID: I20211202000206 |
Provider Name | Hilda Smith |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669841508 PECOS PAC ID: 0042528192 Enrollment ID: I20220221001924 |
Provider Name | Ihuoma Nwogu |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891054920 PECOS PAC ID: 1557650199 Enrollment ID: I20220224000373 |
Provider Name | Tyler Feuerborn |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366941650 PECOS PAC ID: 9032547369 Enrollment ID: I20220322000443 |
Provider Name | Alishka Abioye |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811418627 PECOS PAC ID: 5991041618 Enrollment ID: I20220401000328 |
Provider Name | Carol Ye-shane Lin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295484954 PECOS PAC ID: 4688052194 Enrollment ID: I20220610002069 |
Provider Name | Dyann Avila Avila |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1619103652 PECOS PAC ID: 5698154656 Enrollment ID: I20220622000219 |
Provider Name | Mariangel Champang Zambrano |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356001143 PECOS PAC ID: 2668851635 Enrollment ID: I20220622000620 |
Provider Name | Cindy Suthar |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750815981 PECOS PAC ID: 6204113194 Enrollment ID: I20220802000475 |
Provider Name | Tracy Walker |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1972899078 PECOS PAC ID: 0941521074 Enrollment ID: I20220804000283 |
Provider Name | Aneeqa Shamshad Butt |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1831678226 PECOS PAC ID: 3476936071 Enrollment ID: I20220815001864 |
Provider Name | Kelley Marie Thurston |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477280014 PECOS PAC ID: 3971987306 Enrollment ID: I20220901002994 |
Provider Name | Darrell Tuck |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073243572 PECOS PAC ID: 3678957701 Enrollment ID: I20220908001755 |
Provider Name | Kristen A. Ross |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164007746 PECOS PAC ID: 2860877180 Enrollment ID: I20220922000227 |
Provider Name | Lakimberely Shajuan Wooten |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538881503 PECOS PAC ID: 6608252119 Enrollment ID: I20221006003438 |
Provider Name | Carline Ifeoma Uwajeh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902561608 PECOS PAC ID: 3072980952 Enrollment ID: I20221107000250 |
Provider Name | Justin Givan |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1689026627 PECOS PAC ID: 6608243415 Enrollment ID: I20221108002517 |
Provider Name | Aislinn Rogalla |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1902250400 PECOS PAC ID: 6901137892 Enrollment ID: I20221109000859 |
Provider Name | Shital P Chavda |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306167085 PECOS PAC ID: 3678717675 Enrollment ID: I20230105000015 |
Provider Name | Erica M Francis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508220757 PECOS PAC ID: 8527358720 Enrollment ID: I20230110000071 |
Provider Name | Latisha Clark |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700590320 PECOS PAC ID: 9234502923 Enrollment ID: I20230228001026 |
Provider Name | Morgan Miller |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1992156855 PECOS PAC ID: 4284919945 Enrollment ID: I20230315002578 |
Provider Name | Quanza Elise Mooring |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770281016 PECOS PAC ID: 8224402920 Enrollment ID: I20230321000482 |
Provider Name | Yamila Casas Lay |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306556006 PECOS PAC ID: 1658736681 Enrollment ID: I20230427000141 |
Provider Name | Bernita G Chance |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689784274 PECOS PAC ID: 8921463548 Enrollment ID: I20230503001223 |
Provider Name | Michael David Musgrove |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1720774607 PECOS PAC ID: 1850750522 Enrollment ID: I20230629000756 |
Provider Name | Ashley Saneka Smith |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1881166759 PECOS PAC ID: 5597124115 Enrollment ID: I20230719003903 |
Provider Name | Priscilla Kovacs |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1881211001 PECOS PAC ID: 7416318001 Enrollment ID: I20230728002769 |
Provider Name | Petra Mojica |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457922783 PECOS PAC ID: 9638530082 Enrollment ID: I20230801002450 |
Provider Name | Teresa M Darden |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609550516 PECOS PAC ID: 2769845619 Enrollment ID: I20230825001183 |
Provider Name | Bushra Kanwal |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1740844364 PECOS PAC ID: 0446613210 Enrollment ID: I20230825002422 |
Provider Name | Kumari Iyer |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790982759 PECOS PAC ID: 5496641847 Enrollment ID: I20230907000626 |
Provider Name | Andrea Foster |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467167775 PECOS PAC ID: 3577927748 Enrollment ID: I20230907001084 |
Provider Name | Elizabeth Gonzalez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235821208 PECOS PAC ID: 1254795438 Enrollment ID: I20230907001367 |
Provider Name | Prince Philip |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1497108856 PECOS PAC ID: 8224492327 Enrollment ID: I20230907002864 |
Provider Name | Derrial Doyle |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578253621 PECOS PAC ID: 5799149829 Enrollment ID: I20230907004364 |
Provider Name | Cassandra Melanie Leate |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992776561 PECOS PAC ID: 2961866231 Enrollment ID: I20230919004367 |
Provider Name | Penninah Maina |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205466109 PECOS PAC ID: 0244669570 Enrollment ID: I20231002000597 |
Provider Name | Rochelle Brumfield |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518415959 PECOS PAC ID: 4486935533 Enrollment ID: I20231004001841 |
Provider Name | Mohit Gupta |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1720243181 PECOS PAC ID: 5597936989 Enrollment ID: I20231005001535 |
Provider Name | Sujey Cristina Loera |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1164209086 PECOS PAC ID: 0042665630 Enrollment ID: I20231017003470 |
Provider Name | Melissa O Henry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083495626 PECOS PAC ID: 3678929387 Enrollment ID: I20231031002878 |
Provider Name | Hamayun Nawaz |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1871817189 PECOS PAC ID: 4082868310 Enrollment ID: I20231104000675 |
Provider Name | Meredith Amos |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356609150 PECOS PAC ID: 7618109596 Enrollment ID: I20231110002262 |
Provider Name | Paul Geiger |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891754784 PECOS PAC ID: 5395780936 Enrollment ID: I20231114000045 |
Provider Name | John Nguyen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760198196 PECOS PAC ID: 2365899143 Enrollment ID: I20231116000633 |
Provider Name | Loritta Beacham |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1043093032 PECOS PAC ID: 5890145486 Enrollment ID: I20231221004178 |
Provider Name | Duyen June Magnuson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558043570 PECOS PAC ID: 7719330026 Enrollment ID: I20240201003710 |
Provider Name | James Ronk |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396450425 PECOS PAC ID: 3779928023 Enrollment ID: I20240227001989 |
Provider Name | Feyisayo Olafiranye |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154611069 PECOS PAC ID: 1658548417 Enrollment ID: I20240311000419 |
Provider Name | Rebecca Murray |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1134557473 PECOS PAC ID: 2365675451 Enrollment ID: I20240314001285 |
Provider Name | Markelse Jordan |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1578155198 PECOS PAC ID: 5890134670 Enrollment ID: I20240412000622 |
Provider Name | Davetta A Henderson |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1164069829 PECOS PAC ID: 0941649628 Enrollment ID: I20240415000494 |
Provider Name | Rebekah Serrato |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164288932 PECOS PAC ID: 3577903582 Enrollment ID: I20240424002203 |
Provider Name | Elsa Erika Gomez |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1336570704 PECOS PAC ID: 2961844477 Enrollment ID: I20240530000144 |
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