Active NPI
Agnes Ibeneme, RN
- Rehabilitation Registered Nurse
- Dallas, TX
National Provider Identifier
1215112958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Registered Nurse
- License
- 621898
- Practice address
- 12484 Abrams Rd
#2221
Dallas, TX 75243-1682 - Phone
- (469) 363-6202
- NPI assigned
- Dec 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Rehabilitation Registered Nurse | 163WR0400X | 621898 | TX | Primary |
Addresses
Primary practice location
12484 Abrams Rd
#2221
Dallas, TX 75243-1682
Mailing address
12484 Abrams Rd
#2221
Dallas, TX 75243-1682
Phone (469) 363-6202
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 621898 | TX | MD | Rehabilitation Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199059200000",
"number": "1215112958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12484 ABRAMS RD",
"address_2": "#2221",
"city": "DALLAS",
"state": "TX",
"postal_code": "752431682",
"telephone_number": "469-363-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12484 ABRAMS RD",
"address_2": "#2221",
"city": "DALLAS",
"state": "TX",
"postal_code": "752431682",
"telephone_number": "469-363-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBENEME",
"first_name": "AGNES",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-31",
"last_updated": "2007-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "163WR0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Rehabilitation",
"state": "TX",
"license": "621898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.