Tawanda Nitchelle Bostic, FNP-BC/PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60975928 Issued in WA

Practice address

6000 Western PL
Fort Worth, TX 76107-4607

Phone

(704) 641-7475

NPI assigned

Nov 18, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

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

State licenses

Interoperability endpoints

• Direct secure messaging: tawanda.bostic@3577.securemail.prognocis.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.

• New Heights Behavioral Health, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Charlotte, NC
  • NPI 1053934356
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1154576197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9805 STATESVILLE RD STE 6331",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282697647",
            "telephone_number": "704-641-7475",
            "fax_number": "704-992-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 WESTERN PL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761074607",
            "telephone_number": "704-641-7475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10150 Mallard Creek Rd",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282103297",
            "country_code": "US",
            "telephone_number": "704-510-2662 x110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSTIC",
        "first_name": "TAWANDA",
        "middle_name": "NITCHELLE",
        "name_prefix": "Dr.",
        "credential": "FNP-BC/PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-18",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NC",
            "license": "196483",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "APRN-LIC-127603",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "196483",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "196483",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60975928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCBON- RN LICENSE",
            "identifier": "196483",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC- FNP CERTIFICATION",
            "identifier": "2008006354",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC",
            "identifier": "2013020566",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA APRN LICENSE",
            "identifier": "APRN-LIC-127603",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan Alex Boshart, PT, DPT
• Judy P Boshart, MS CCCSLP
• Lillian Connie Bosire, PMHNP
• Terra Carter Bossard, LVN
• Leila Bostan Shirin, M.D.
• Kaci Bostick, APRN
• Mitchell Boston, MS, BCBA, LBA
• Rebecca Boswell
• Joyce Botchey-Niiquaye, FNP
• Marina Botros

• Psychiatric/Mental Health Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.