Connie Nellum, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

528675 Issued in TX

Practice address

909 Morrison Dr
Mesquite, TX 75150-6079

Phone

(214) 398-4157

Fax

(214) 398-4326

NPI assigned

May 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Nurse Practitioner

State licenses

Practice roles

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.

• South Loop 12 Medical Clinic LLC

  • Family Nurse Practitioner
  • Dallas, TX
  • NPI 1417034745
  Medicare reassignment Authorized official
• Bonnieview-Overton Medical Clinic

  • Clinic/Center
  • Dallas, TX
  • NPI 1417566415
  Authorized official Same address or phone
• Association for Improving Medical Accessibility Corporation

  • Family Nurse Practitioner
  • Dallas, TX
  • NPI 1538229505
  NPD (past)
• Association for Improving Medical Services

  dba Hackberry House

  • Assisted Living Facility
  • Lancaster, TX
  • NPI 1063606697

  Family

  NPD (past)
• Consultants in Radiology PA

  • Diagnostic Radiology Physician
  • Hurst, TX
  • NPI 1922034602
  NPD (past)
• Residential Visits Association

  dba Dr's Home Visits

  • Geriatric Medicine (Family Medicine) Physician
  • Dallas, TX
  • NPI 1477529352
  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184830473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 S LOOP 12 # 202B",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752176607",
            "telephone_number": "214-398-4157",
            "fax_number": "214-398-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 MORRISON DR",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506079",
            "telephone_number": "214-398-4157",
            "fax_number": "214-398-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELLUM",
        "first_name": "CONNIE",
        "name_prefix": "Ms.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "528675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natural Dentistry of North Texas, PLLC
• Daniel Charles Naughton, LCSW
• Ne3 Enterprises, LLC (Puzzle Piece Kids)
• Oby Betrice Nebe, RN
• Neema Psychiatry PLLC
• Neo Physical Therapy LLC
• Neo Physical Therapy LLC
• Ness Home Health Service, LLC
• Taquasha Nettles
• Network Provider Associates, P.C. (Creek Crossing Dental Care and Orthodontics)

• Family Nurse Practitioner in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.