Active NPI
Kochumole Daniel
- Family Nurse Practitioner
- Dallas, TX
National Provider Identifier
1255830949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP136495
- Practice address
- 4500 S Lancaster Rd
Dallas, TX 75216-7167 - Phone
- (214) 742-8387
- NPI assigned
- Feb 7, 2018
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP136495 | TX | Primary |
Addresses
Primary practice location
4500 S Lancaster Rd
Dallas, TX 75216-7167
Mailing address
3707 Northaven Rd
Dallas, TX 75229-2753
Phone (972) 971-0882
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211215000987 | TX | Order and Referring Only - Nurse Practitioner | 5698166205 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517961600000",
"number": "1255830949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3707 NORTHAVEN RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752292753",
"telephone_number": "972-971-0882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 S LANCASTER RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752167167",
"telephone_number": "214-742-8387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIEL",
"first_name": "KOCHUMOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-07",
"last_updated": "2018-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP136495",
"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 Feb 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.