NPIMap

Organization Active NPI

Dragonfly Telehealth, Inc.

  • Clinic/Center
  • Streetman, TX
National Provider Identifier
1215689799
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DRAGONFLY TELEHEALTH, INC.
Practice address
160 September Dr
Streetman, TX 75859-3261
Phone
(931) 628-9210
NPI assigned
Jan 25, 2022
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Kimberly Modena Tatum, FNP-CNPI 1518479542
Title
Ceo
Phone
(931) 628-9210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

160 September Dr
Streetman, TX 75859-3261

Mailing address

160 September Dr
Streetman, TX 75859-3261
Phone (931) 628-9210

Other practice location 1

160 September Dr
Streetman, TX 75859-3261
Phone (931) 628-9210

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1215689799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 SEPTEMBER DR",
            "city": "STREETMAN",
            "state": "TX",
            "postal_code": "758593261",
            "telephone_number": "931-628-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 SEPTEMBER DR",
            "city": "STREETMAN",
            "state": "TX",
            "postal_code": "758593261",
            "telephone_number": "931-628-9210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 September Dr",
            "address_purpose": "LOCATION",
            "city": "Streetman",
            "state": "TX",
            "postal_code": "758593261",
            "country_code": "US",
            "telephone_number": "931-628-9210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DRAGONFLY TELEHEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "MODENA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-628-9210",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Streetman, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.