Lynn Idell Mogensen, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1025471 Issued in TX

Practice address

2004 Nottingham Blvd
Fort Worth, TX 76112-5229

Phone

(530) 949-1291

NPI assigned

Jan 20, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Lynn Idell Latour Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Anchor Functional Medicine Associates, PLLC

  • Medical Specialty Clinic/Center
  • Irving, TX
  • NPI 1225714454
  NPD

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1093305401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 NOTTINGHAM BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761125229",
            "telephone_number": "530-949-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 NOTTINGHAM BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761125229",
            "telephone_number": "530-949-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGENSEN",
        "first_name": "LYNN",
        "middle_name": "IDELL",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1025471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYNN",
            "last_name": "LATOUR",
            "middle_name": "IDELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lynet Bonareri Moenga, APRN
• Adris Moffett, LMSW
• Jessica Michelle Moffett, COTA
• Arya Mofidi, DDS
• Christine Michelle Mogan, LPC-A
• Bayan Mogharrabi
• Omar Moghrabi, DO
• Carolyn Moore Mohair, OT
• Mohamad Saad DO PLLC
• Ali Abbas Mohamedi, MD

• Family Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.