NPIMap

Individual provider Active NPI

Washington Odhiambo Mitema, FNP

  • Family Nurse Practitioner
  • Roanoke, TX
National Provider Identifier
1154709798
Registry record updated Jul 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
724406 Issued in TX
Practice address
1305 US-377 Hwy
Roanoke, TX 76262
Phone
(682) 831-1923
NPI assigned
May 15, 2015
Last updated
Jul 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2023

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 724406 TX Primary

Addresses

Primary practice location

1305 US-377 Hwy
Roanoke, TX 76262

Mailing address

1305 US-377 Hwy
Roanoke, TX 76262
Phone (682) 831-1923

Other practice location 1

2716 Cedar Ridge Ln
Fort Worth, TX 76177-2111
Phone (682) 234-0660

Other identifiers 1

IdentifierTypeStateIssuer
724406OtherTXTEXAS BOARD OF NURSING

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
I20151007002723 TX Practitioner - Nurse Practitioner 4385952530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

East Hwy 18
Pine Ridge, SD 57770-1201
Phone (605) 867-3032

P O Box
Suite 1201
Pine Ridge, SD 57770-1201

P O Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201

PO Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
724406TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jan 21, 2026 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jan 21, 2026 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: washington.mitema.1@14940.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1431648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688256000000",
    "number": "1154709798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 US-377 HWY",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "76262",
            "telephone_number": "682-831-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 US-377 HWY",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "76262",
            "telephone_number": "682-831-1923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2716 Cedar Ridge Ln",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761772111",
            "country_code": "US",
            "telephone_number": "682-234-0660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITEMA",
        "first_name": "WASHINGTON",
        "middle_name": "ODHIAMBO",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-15",
        "last_updated": "2023-07-02",
        "certification_date": "2023-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "724406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF NURSING",
            "identifier": "724406",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, TX

Sources for this page

Verify at the official NPI Registry.