Nicole Minshew, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06253 Issued in TX

Practice address

2550 River Park PLZ
Suite110
Fort Worth, TX 76116-0920

Phone

(817) 731-1289

Fax

(817) 731-1291

NPI assigned

Mar 19, 2009

Last updated

Sep 8, 2014By the provider in NPPES

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

Other identifiers 1

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

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Quang Trong Le DO PA

  dba River Park Medical Clinic

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1417954389
  Medicare reassignment

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

{
    "created_epoch": "1237420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410134400000",
    "number": "1144461260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 RIVER PARK PLZ",
            "address_2": "SUITE110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160920",
            "telephone_number": "817-731-1289",
            "fax_number": "817-731-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 RIVER PARK PLZ",
            "address_2": "SUITE110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160920",
            "telephone_number": "817-731-1289",
            "fax_number": "817-731-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINSHEW",
        "first_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-19",
        "last_updated": "2014-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203461301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.