Active NPI
Mona Kidwell, N.P.
- Adult Health Nurse Practitioner
- League City, TX
National Provider Identifier
1043571243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 508280
- Practice address
- 2785 Gulf Fwy S
Suite 115
League City, TX 77573-4979 - Phone
- (832) 816-1370
- NPI assigned
- Jun 4, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 508280 | TX | Primary |
Addresses
Primary practice location
2785 Gulf Fwy S
Suite 115
League City, TX 77573-4979
Mailing address
2785 Gulf Fwy S
Suite 115
League City, TX 77573-4979
Phone (832) 816-1370
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 88N956 | Other | TX | BCBS |
| 3031130-01 | Medicaid | TX | |
| 2035487-02 | Medicaid | TX | |
| P01095012 | Other | TX | RAIL ROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Occupational and Family Medicine of South Texas | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Pasadena, TX
- NPI 1780639138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433635200000",
"number": "1043571243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2785 GULF FWY S",
"address_2": "SUITE 115",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775734979",
"telephone_number": "832-816-1370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2785 GULF FWY S",
"address_2": "SUITE 115",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775734979",
"telephone_number": "832-816-1370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDWELL",
"first_name": "MONA",
"credential": "N.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-04",
"last_updated": "2015-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "TX",
"license": "508280",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "88N956",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3031130-01",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2035487-02",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "P01095012",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in League City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.