Individual provider Active NPI

Fasika T Enyew, FNP-C

  • Family Nurse Practitioner
  • Gainesville, GA
National Provider Identifier
1124676218
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
214850 Issued in GA
Practice address
1870 Atlanta Hwy
Gainesville, GA 30504-5948
Phone
(770) 534-0670
NPI assigned
Aug 31, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 214850 GA Primary

Addresses

Primary practice location

1870 Atlanta Hwy
Gainesville, GA 30504-5948

Mailing address

314 Calstone Dr
Allen, TX 75013-2975
Phone (972) 837-7323

Other practice location 1

808 W Interstate 20 # Site210A
Arlington, TX 76017-5818
Phone (817) 725-8199

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231030000329 TX Practitioner - Nurse Practitioner 7810343795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Health Physicians PLLCGroup PAC ID 7810237740, 240 clinicians

Practice addresses (Care Compare)

4844 Greenville Ave
Dallas, TX 75206-4120
Phone (214) 295-9410

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
214850GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Health Physicians, PLLC CurrentSince Jul 28, 2023 Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

4844 Greenville Ave
Dallas, TX 75206
Phone (214) 295-8410

2310 W University Dr
#1500
Denton, TX 76201
Phone (940) 220-5901

104 S Main St
Keller, TX 76248
Phone (214) 295-9385

377 W Campbell Rd
Ste 100
Richardson, TX 75080
Phone (469) 232-2945

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": "1567209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1124676218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 CALSTONE DR",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750132975",
            "telephone_number": "972-837-7323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 ATLANTA HWY",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305045948",
            "telephone_number": "770-534-0670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "808 W Interstate 20 # Site210A",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760175818",
            "country_code": "US",
            "telephone_number": "817-725-8199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENYEW",
        "first_name": "FASIKA",
        "middle_name": "T",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-31",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "214850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.