Mafon Fomujang, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1048371 Issued in TX

Practice address

2911 Medical Arts St Ste 10
Austin, TX 78705-3302

Phone

(866) 473-0663

NPI assigned

Apr 26, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brave Health Medical Group, PAGroup PAC ID 9537586052, 93 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mafon.fomujang.1@23300.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brave Health Medical Group PA

  • Community/Behavioral Health Agency
  • Miami, FL
  • NPI 1225669161

  OH, TX

  Medicare reassignment Care Compare group
• Post Acute Specialists of Texas PA

  • Geriatric Medicine (Family Medicine) Physician
  • Austin, TX
  • NPI 1942859350

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Murtis Taylor Human Services System

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cleveland, OH
  • NPI 1629001920
  Medicare reassignment NPD
• Rakesh Ranjan M.D. & Assoc., Inc.

  • Clinical Medical Laboratory
  • Garfield Heights, OH
  • NPI 1033143722

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Rakesh Ranjan MD & Associates, Inc.

  • Specialty Pharmacy
  • Garfield Heights, OH
  • NPI 1225435597
  NPD
• Lenzy Family Institute

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Canton, OH
  • NPI 1003307810
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1013442102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32638 HARVEST VALLEY DR",
            "city": "BROOKSHIRE",
            "state": "TX",
            "postal_code": "774232908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 MEDICAL ARTS ST STE 10",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787053302",
            "telephone_number": "866-473-0663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Salt Creek Run",
            "address_purpose": "LOCATION",
            "city": "Peninsula",
            "state": "OH",
            "postal_code": "442649461",
            "country_code": "US",
            "telephone_number": "405-549-6290",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12395 McCracken Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Garfield Heights",
            "state": "OH",
            "postal_code": "441252946",
            "country_code": "US",
            "telephone_number": "216-587-6727",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1930 Fulton Rd NW # 103",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447093526",
            "country_code": "US",
            "telephone_number": "330-956-5936",
            "fax_number": "330-956-5623",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13422 Kinsman Rd",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441204410",
            "country_code": "US",
            "telephone_number": "866-536-6038 x2611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOMUJANG",
        "first_name": "MAFON",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-26",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "OH",
            "license": "023666",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.023666",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1048371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Marie Folmar, M.S. CCC-SLP
• Katherine Marie Folse, M.D.
• Shelby Folsom
• Erin B Foltz, MM, MT-BC
• Alex Folwarski
• Christina Bruni Fondren, LCSW
• Katherine K Fong, MD
• Valerie C Fong, DDS
• Jennifer Hope Fonken, P.T.
• Katherine Fonken, R.PH.

• Psychiatric/Mental Health Nurse Practitioner in Austin, TX
• Providers in Austin, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.