Jenica M Rose-Stine, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M8294 Issued in TX

Practice address

136 El Chico TRL Ste 102
Willow Park, TX 76087-8864

Phone

(817) 441-5412

Fax

(817) 441-9354

NPI assigned

May 4, 2007

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

Electronic endpoints 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jrosestine16690@cookchildrens.direct-ci.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.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment NPD
• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1083472062
  NPD
• Cook Children'S Medical Center

  • Clinical Child & Adolescent Psychologist
  • Fort Worth, TX
  • NPI 1942509963
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1174735872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 EL CHICO TRL STE 102",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760878864",
            "telephone_number": "817-441-5412",
            "fax_number": "817-441-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE-STINE",
        "first_name": "JENICA",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M8294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jrosestine16690@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "3200 Riverfront Dr",
            "address_2": "STE 103",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761076570",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jrosestine16690@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "136 El Chico Trl Ste 102",
            "city": "Willow Park",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760878864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tonya Tai Pulis, LPC ASSOCIATE, MS
• Kristina Quinn, M.ED, LPC ASSOCIATE
• Heather Rabon
• Makayla Brysha Roberson, BSW
• Robert Casey Stroud, D.D.S., P.C.
• Hannah Sain
• Deidra Saina, LCSW
• Angelica Maria Salazar, PA
• Mahalia Sanchez, RBT
• Angela Rivers Saunders, D.O.

• Pediatrics Physician in Willow Park, TX
• Providers in Willow Park, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.