T'juaniequa Wideman, AGACNP-BC in Tyler, TX - Medicare Nurse Practitioner

T'juaniequa Wideman, AGACNP-BC is a medicare enrolled "Nurse Practitioner" in Tyler, Texas. Her current practice location is 800 E Dawson St, Tyler, Texas. You can reach out to her office (for appointments etc.) via phone at (903) 593-8441.

T'juaniequa Wideman is licensed to practice in Texas (license number 1115976) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1053195982.

Contact Information

	T'juaniequa Wideman, AGACNP-BC
	800 E Dawson St, Tyler, TX 75701-2036
	(903) 593-8441
	Not Available

Map and Direction

Provider's Profile

Full Name	T'juaniequa Wideman
Gender	Female
Speciality	Nurse Practitioner
Location	800 E Dawson St, Tyler, Texas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1053195982
Provider Enumeration Date: 08/22/2023
Last Update Date: 09/22/2023

Medicare PECOS Information:

PECOS PAC ID: 3274988449
Enrollment ID: I20231006003276

Medical Identifiers

Medical identifiers for T'juaniequa Wideman such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1053195982	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LG0600X	Nurse Practitioner - Gerontology	1115976 (Texas)	Secondary
363L00000X	Nurse Practitioner	1115976 (Texas)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. T'juaniequa Wideman allows following entities to bill medicare on her behalf.

Entity Name	Christus Trinity Clinic
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1285684225 PECOS PAC ID: 3072426741 Enrollment ID: O20031204001091

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. T'juaniequa Wideman is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
T'juaniequa Wideman, AGACNP-BC 1309 S Azalea Dr, Tyler, TX 75701-5222 Ph: (903) 520-4873	T'juaniequa Wideman, AGACNP-BC 800 E Dawson St, Tyler, TX 75701-2036 Ph: (903) 593-8441

Reviews and Comments

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T'juaniequa Wideman, AGACNP-BC - Medicare Nurse Practitioner in Tyler, TX