Dana Lynne Landavazo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA07414 Issued in TX

Practice address

10601 N Riverside Dr
Keller, TX 76244-2118

Phone

(817) 347-2600

Fax

(817) 247-2650

NPI assigned

Jan 10, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Dana Lynne Mailen Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: dlandavazo14981@cookchildrens.direct-ci.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.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment
• Cook Children'S Medical Center

  • Clinical Child & Adolescent Psychologist
  • Fort Worth, TX
  • NPI 1942509963
  NPD (past)
• Nicole Golding, M.D., P.S.C.

  • Physical Medicine & Rehabilitation Physician
  • Topeka, KS
  • NPI 1922144054

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1053597989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10601 N RIVERSIDE DR",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762442118",
            "telephone_number": "817-347-2600",
            "fax_number": "817-247-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDAVAZO",
        "first_name": "DANA",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-10",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dlandavazo14981@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "10601 N Riverside Dr",
            "city": "Keller",
            "state": "TX",
            "country_code": "US",
            "postal_code": "762442118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DANA",
            "last_name": "MAILEN",
            "middle_name": "LYNNE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Angela Danielle Lagle, RBT
• Krystal Lambert, LCSW
• Pamela Calabria Lancarte, R.N., N.P.
• Jennifer Land
• Mariah Land
• Julia Landavazo, OD
• Heather Irby Landeros
• Landing Hand Care LLC
• Laney Chiropractic & Sports Therapy, PA
• Laney Enterprises, Inc

• Physician Assistant in Keller, TX
• Providers in Keller, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.