Individual provider Active NPI

Nina Haddad

  • Nurse Practitioner
  • Killeen, TX
National Provider Identifier
1023611084
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1028919 Issued in TX
Practice address
5703 Boxelder TRL
Killeen, TX 76542-5395
Phone
(254) 289-2197
NPI assigned
Nov 20, 2020
Last updated
May 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1028919 TX Primary
Registered Nurse 163W00000X 916540 TX

Addresses

Primary practice location

5703 Boxelder TRL
Killeen, TX 76542-5395

Mailing address

5703 Boxelder TRL
Killeen, TX 76542-5395
Phone (254) 289-2197

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210715003506 TX Practitioner - Nurse Practitioner 0840692612 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians Emergency Medicine of Texas PLLCGroup PAC ID 9739449802, 112 clinicians

Practice addresses (Care Compare)

2201 Clear Creek Rd
Killeen, TX 76549-4110
Phone (254) 526-7523

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
916540TXMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Associates of Central Texas PA Nurse Practitioner CurrentSince Aug 1, 2021 Accepting new patients
Sound Physicians Emergency Medicine of Texas PLLC Nurse Practitioner CurrentSince Dec 14, 2024 Accepting new patients

Locations

1275 Marvin Hancock Dr
Jasper, TX 75951
Phone (409) 384-1951

2201 Clear Creek Rd
Killeen, TX 76549
Phone (254) 519-8185

3600 Gates Blvd
Port Arthur, TX 77642
Phone (409) 985-7431

Organizations & group practices 2

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1023611084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5703 BOXELDER TRL",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765425395",
            "telephone_number": "254-289-2197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5703 BOXELDER TRL",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765425395",
            "telephone_number": "254-289-2197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "NINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-20",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1028919",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "916540",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.