Individual provider Active NPI

Gwendolyn L Waddle, FNP

  • Family Nurse Practitioner
  • Temple, TX
National Provider Identifier
1255381489
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
555969 Issued in TX
Practice address
2401 S 31St St
Temple, TX 76508-7919
Phone
(245) 724-2111
NPI assigned
May 10, 2006
Last updated
Jan 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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 555969 TX Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-7919

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gwaddle66851@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5401 Airport Rd
Revenue Cycle Operations Provider Enrol
Temple, TX 76502-7092

5701 Airport Rd
Temple, TX 76502-7092

Rco Provider Enrollment
5701 Airport Rd Ms Ar M200
Temple, TX 76502-7092

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
555969TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medhealth Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: gwaddle66851@direct.sw.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1255381489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765087919",
            "telephone_number": "245-724-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDLE",
        "first_name": "GWENDOLYN",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "555969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gwaddle66851@direct.sw.org",
            "affiliation": "N",
            "address_1": "2401 S 31st St",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765087919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.