NPIMap

Individual provider Active NPI

Enobong C. Udo, A-GNP

  • Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1124518253
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP137519 Issued in TX
Practice address
2231 Butler St
Dallas, TX 75235-7826
Phone
(214) 590-0409
Fax
(214) 590-0413
NPI assigned
May 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP137519 TX
Gerontology Nurse Practitioner 363LG0600X AP137519 TX
Primary Care Nurse Practitioner 363LP2300X AP137519 TX
Nurse Practitioner 363L00000X AP137519 TX Primary

Addresses

Primary practice location

2231 Butler St
Dallas, TX 75235-7826

Mailing address

2231 Butler St
Dallas, TX 75235-7826
Phone (214) 590-0409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180821002634 TX Practitioner - Nurse Practitioner 3072862242 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dallas County Hospital DistrictGroup PAC ID 8325934813, 597 clinicians

Practice addresses (Care Compare)

802 Hopkins St
Garland, TX 75040-7379
Phone (214) 266-0700

Hospital & facility affiliations

  • Parkland Health & Hospital System Hospital, Dallas, TX, CCN 450015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP137519TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Hospital District Nurse Practitioner CurrentSince Feb 22, 2023 Accepting new patients
Solar Health, P.a. CurrentSince Jan 15, 2020 Accepting new patients
Dallas County Hospital District Nurse Practitioner CurrentSince Feb 22, 2023 Accepting new patients
Dallas County Hospital District Nurse Practitioner Current Accepting new patients
Solar Health, P.a. CurrentSince Jan 15, 2020 Accepting new patients
Dallas County Hospital District Past Accepting new patients
Dallas Pain Institute PastSince Jan 29, 2023 Accepting new patients

Locations

2231 Butler St
Dallas, TX 75235
Phone (214) 590-5224

2231 Butler St
#150
Dallas, TX 75235
Phone (214) 590-8396

802 Hopkins St
Garland, TX 75040
Phone (214) 266-0665

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

910 N Galloway Ave
#302
Mesquite, TX 75149
Phone (972) 301-8897

811 S Central Expy
Ste 103
Richardson, TX 75080
Phone (972) 310-7121

Interoperability endpoints

  • Direct secure messaging: eudo320478@direct.phhs.org

Organizations & group practices 9

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.

Hospital & facility affiliations 45

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1124518253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2231 BUTLER ST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357826",
            "telephone_number": "214-590-0409",
            "fax_number": "214-590-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 BUTLER ST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357826",
            "telephone_number": "214-590-0409",
            "fax_number": "214-590-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDO",
        "first_name": "ENOBONG",
        "middle_name": "C.",
        "credential": "A-GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-15",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP137519",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP137519",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP137519",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP137519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.