Individual provider Active NPI

Krista Renee Qualls, NP

  • Primary Care Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1245747351
Registry record updated Jan 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP136152 Issued in TX
Practice address
1000 Lipscomb St Ste 110
Fort Worth, TX 76104-3181
Phone
(817) 348-8600
Fax
(817) 348-8602
NPI assigned
Jan 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X AP136152 TX Primary

Addresses

Primary practice location

1000 Lipscomb St Ste 110
Fort Worth, TX 76104-3181

Mailing address

1000 Lipscomb St Ste 110
Fort Worth, TX 76104-3181
Phone (817) 348-8600

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
I20180226001088 TX Practitioner - Nurse Practitioner 4981965498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Restoration Integrated Health PLLCGroup PAC ID 4981146073, 2 clinicians

Practice addresses (Care Compare)

7948 Davis Blvd
Suite 200
North Richland Hills, TX 76182-6954
Phone (817) 500-4331

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP136152TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Restoration Integrated Health PLLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

7948 Davis Blvd
North Richland Hills, TX 76182
Phone (817) 500-4331

7948 Davis Blvd
Ste 200
North Richlnd Hls, TX 76182
Phone (817) 500-4331

Organizations & group practices 1

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": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1245747351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 LIPSCOMB ST STE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043181",
            "telephone_number": "817-348-8600",
            "fax_number": "817-348-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 LIPSCOMB ST STE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043181",
            "telephone_number": "817-348-8600",
            "fax_number": "817-348-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLS",
        "first_name": "KRISTA",
        "middle_name": "RENEE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-10",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP136152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.