Active NPI
Dominique Kwaine Idahor
- Registered Nurse
- Fort Worth, TX
National Provider Identifier
1053780254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 08933451
- Practice address
- 5813 Lincoln Meadows CT
409
Fort Worth, TX 76112-1451 - Phone
- (817) 986-6999
- NPI assigned
- Sep 17, 2015
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 08933451 | TX | Primary |
Addresses
Primary practice location
5813 Lincoln Meadows CT
409
Fort Worth, TX 76112-1451
Mailing address
5813 Lincoln Meadows CT
409
Fort Worth, TX 76112-1451
Phone (817) 986-6999
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08933451 | TX | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442448000000",
"number": "1053780254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5813 LINCOLN MEADOWS CT",
"address_2": "409",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761121451",
"telephone_number": "817-986-6999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5813 LINCOLN MEADOWS CT",
"address_2": "409",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761121451",
"telephone_number": "817-986-6999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDAHOR",
"first_name": "DOMINIQUE",
"middle_name": "KWAINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-17",
"last_updated": "2015-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "08933451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
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- Ideal Dental of West 7TH PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.