Individual provider Active NPI

Kehinde M Kulugh, FNP-BC

  • Family Nurse Practitioner
  • Grand Prairie, TX
National Provider Identifier
1174060784
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11160 Issued in CT
Practice address
7023 Morning Star Dr
Grand Prairie, TX 75054-7241
Phone
(718) 207-0266
NPI assigned
Jan 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 341216 NY
Family Nurse Practitioner 363LF0000X 11160 CT Primary
Family Nurse Practitioner 363LF0000X 1055860 TX

Addresses

Primary practice location

7023 Morning Star Dr
Grand Prairie, TX 75054-7241

Mailing address

7023 Morning Star Dr
Grand Prairie, TX 75054-7241
Phone (718) 207-0266

Other practice location 1

1094 Killingly Commons Dr
Dayville, CT 06241-2187
Phone (727) 601-4513

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT, TX3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20170824003353 NY Practitioner - Nurse Practitioner 3779855796 Reassigns benefits to 1 organization
I20241113002600 CT Practitioner - Nurse Practitioner 3779855796
I20250416003385 TX Practitioner - Nurse Practitioner 3779855796 Reassigns benefits to 1 organization
Practice locations: Grand Prairie, TX

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1055860TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Onmed Professional Services PA CurrentSince Dec 1, 2024 Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Jun 28, 2017 Accepting new patients
Cloud Health Medical Group, P.a. Past Accepting new patients
Harwood Healthcare Corp PastSince Feb 4, 2024 Accepting new patients

Locations

14105 McCormick Dr
Tampa, FL 33626
Phone (727) 601-4513

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

512 N Jefferson Ave
Cameron, TX 76520
Phone (813) 543-4051

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: kehinde.kulugh@337577483108356.direct.elationemr.com
  • Direct secure messaging: kehinde.kulugh.1@30885.direct.athenahealth.com

Organizations & group practices 4

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": "1484956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1174060784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7023 MORNING STAR DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750547241",
            "telephone_number": "718-207-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7023 MORNING STAR DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750547241",
            "telephone_number": "718-207-0266"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1094 Killingly Commons Dr",
            "address_purpose": "LOCATION",
            "city": "Dayville",
            "state": "CT",
            "postal_code": "062412187",
            "country_code": "US",
            "telephone_number": "727-601-4513",
            "fax_number": "813-940-7440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KULUGH",
        "first_name": "KEHINDE",
        "middle_name": "M",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-21",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341216",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "11160",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1055860",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.