Active NPI
Enna I Amedome, FNP-C
- Family Nurse Practitioner
- Dallas, TX
National Provider Identifier
1124511993
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective May 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 20837985
- Practice address
- 4055 Valley View LN
Dallas, TX 75244-5074 - Phone
- (877) 868-5361
- NPI assigned
- Jun 7, 2018
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 20837985 | TX | Primary |
Addresses
Primary practice location
4055 Valley View LN
Dallas, TX 75244-5074
Mailing address
4055 Valley View LN
Dallas, TX 75244-5074
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20837985 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587772800000",
"number": "1124511993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4055 VALLEY VIEW LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752445074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4055 VALLEY VIEW LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752445074",
"telephone_number": "877-868-5361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMEDOME",
"first_name": "ENNA",
"middle_name": "I",
"credential": "FNP-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-07",
"last_updated": "2020-04-25",
"certification_date": "2020-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "20837985",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.