Active NPI
Diana R Koon, NP
- Family Nurse Practitioner
- Mesquite, TX
National Provider Identifier
1205009735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 563192
- Practice address
- 1675 Republic Pkwy Ste 100
Mesquite, TX 75150-6902 - Phone
- (972) 620-9111
- Fax
- (972) 620-9187
- NPI assigned
- Apr 4, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 563192 | TX | Primary |
Addresses
Primary practice location
1675 Republic Pkwy Ste 100
Mesquite, TX 75150-6902
Mailing address
1675 Republic Pkwy Ste 100
Mesquite, TX 75150-6902
Phone (972) 620-9111
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 151079402 | Medicaid | TX | |
| 151079403 | Medicaid | TX | |
| 151079404 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians and Allied Health Professionals Group, PA | Past | Accepting new patients | |
| Cardiovascular Consultants of North Texas, LLP | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/24058/brand/1/csg/1/fhir/r4
Organizations & group practices 2
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.
-
- Cardiovascular Disease Physician
- Grapevine, TX
- NPI 1528210663
-
- Family Medicine Physician
- Dallas, TX
- NPI 1528011814
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304035200000",
"number": "1205009735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 REPUBLIC PKWY STE 100",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751506902",
"telephone_number": "972-620-9111",
"fax_number": "972-620-9187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1675 REPUBLIC PKWY STE 100",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751506902",
"telephone_number": "972-620-9111",
"fax_number": "972-620-9187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOON",
"first_name": "DIANA",
"middle_name": "R",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-04",
"last_updated": "2011-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "563192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151079402",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151079403",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151079404",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.