Jacqueline Renee Berend, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

661133 Issued in TX

Practice address

1631 11TH St
Wichita Falls, TX 76301-4320

Phone

(940) 687-5100

Fax

(940) 687-3500

NPI assigned

Mar 16, 2006

Reactivated

Apr 18, 2006

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

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

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jberend13401@unitedregional.medalliesdirect.net
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/URMYCHART/api/FHIR/R4
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• United Regional Physician Group

  • Family Medicine Physician
  • Wichita Falls, TX
  • NPI 1407890775
  Medicare reassignment NPD
• United Regional Health Care System Inc

  • General Acute Care Hospital
  • Wichita Falls, TX
  • NPI 1023013448
  NPD

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1093784464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64",
            "city": "WINDTHORST",
            "state": "TX",
            "postal_code": "763890064",
            "telephone_number": "940-423-6518",
            "fax_number": "940-687-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 11TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014320",
            "telephone_number": "940-687-5100",
            "fax_number": "940-687-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEREND",
        "first_name": "JACQUELINE",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2011-05-16",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "661133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Elizabeth Bennett, LPC-A
• Paula Theresa Bennett, LPC-S
• Benny F Fleming DDS PC
• Rachel Nicole Benson, RBT
• Tyshionna Benson, ST
• Klonie L Berend, M.D.
• Shane Berend, P.T.
• Susan Berend
• Bernard Chiropractic & Wellness PA
• Bernard Chiropractic & Wellness PA

• Nurse Practitioner in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.