Thaila Keodouangdy

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-136625 Issued in AL

Practice address

19250 N Mobile St
Citronelle, AL 36522-2122

Phone

(251) 866-9126

NPI assigned

May 14, 2020

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mobile County Board of HealthGroup PAC ID 9931208386, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thaila.keodouangdy.1@15479.direct.athenahealth.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.

• Mobile County Board of Health

  • Federally Qualified Health Center (FQHC)
  • Mobile, AL
  • NPI 1063439065
  Medicare reassignment Care Compare group NPD
• Mobile County Board of Health

  • State or Local Public Health Clinic/Center
  • Mobile, AL
  • NPI 1720257199
  NPD
• Mobile County Board of Health

  • Federally Qualified Health Center (FQHC)
  • Mobile, AL
  • NPI 1861403594
  NPD

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1104448919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2867",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366522867",
            "telephone_number": "251-690-8158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 N MOBILE ST",
            "city": "CITRONELLE",
            "state": "AL",
            "postal_code": "365222122",
            "telephone_number": "251-866-9126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "251 N Bayou St",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366035827",
            "country_code": "US",
            "telephone_number": "251-690-8158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEODOUANGDY",
        "first_name": "THAILA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-14",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-136625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261555",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Clay Garver, DMD
• Gmuc of Citronelle LLC
• Hearts of Harmony Homecare LLC
• Edmond Charles Henson, M.D., P.H.D.
• Lymenda Hrinsin
• Charles Lipe
• Mobile County Board of Health
• Mobile County Board of Health
• Natchez Medical Supply, LLC
• Nursetel

• Family Nurse Practitioner in Citronelle, AL
• Providers in Citronelle, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.