Individual provider Active NPI

Monique Ukpong, APRN

  • Family Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1235964685
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1152827 Issued in TX
Practice address
7033 Bryant Irvin Rd Ste 100
Fort Worth, TX 76132-4276
Phone
(469) 600-0802
NPI assigned
Sep 5, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1152827 TX Primary

Addresses

Primary practice location

7033 Bryant Irvin Rd Ste 100
Fort Worth, TX 76132-4276

Mailing address

3535 Bluffs LN Apt 12208
Grapevine, TX 76051-1238
Phone (469) 600-0802

Other names 1

  • Monique Pouliot Other name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241017004280 TX Practitioner - Nurse Practitioner 6002348810 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1152827TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Revive Med Partners I LLC CurrentSince Dec 8, 2025 Accepting new patients
Helical Health PLLC CurrentSince Oct 1, 2024 Accepting new patients
Revive Med Partners, LLC Family CurrentSince Dec 20, 2025 Accepting new patients

Locations

1124 Glade Rd
Ste 160
Colleyville, TX 76034
Phone (817) 984-3460

8845 Davis Blvd
Ste 100
Keller, TX 76248
Phone (817) 900-9525

2570 Justin Rd
Ste 160
Lewisville, TX 75077
Phone (972) 236-7060

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFADCD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1725494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1235964685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 BLUFFS LN APT 12208",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760511238",
            "telephone_number": "469-600-0802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7033 BRYANT IRVIN RD STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324276",
            "telephone_number": "469-600-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UKPONG",
        "first_name": "MONIQUE",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1152827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONIQUE",
            "last_name": "POULIOT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.