Individual provider Active NPI

Jeanette Lopez

  • Physician Assistant
  • Mansfield, TX
National Provider Identifier
1093671489
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA20199 Issued in TX
Practice address
1759 Broad Park Cir S Ste 201
Mansfield, TX 76063-7834
Phone
(682) 341-3910
NPI assigned
Dec 29, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA20199 TX Primary

Addresses

Primary practice location

1759 Broad Park Cir S Ste 201
Mansfield, TX 76063-7834

Mailing address

1759 Broad Park Cir S Ste 201
Mansfield, TX 76063-7834
Phone (682) 341-3910

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

LicenseStateTypeSpecialty
PA20199TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kidsville Pediatrics PLLC Physician Assistant PastSince Jan 25, 2026 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.

NPI Registry JSON

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

{
    "created_epoch": "1766966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777593600000",
    "number": "1093671489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1759 BROAD PARK CIR S STE 201",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637834",
            "telephone_number": "682-341-3910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1759 BROAD PARK CIR S STE 201",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637834",
            "telephone_number": "682-341-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "JEANETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-29",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA20199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.