Active NPI
Nicole Kay Detweiler, APRN-CNP
- Nurse Practitioner
- Houston, TX
National Provider Identifier
1265157440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1096254
- Practice address
- 6411 Fannin St
Houston, TX 77030-1501 - Phone
- (713) 704-6576
- NPI assigned
- Oct 10, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1096254 | TX | Primary |
Addresses
Primary practice location
6411 Fannin St
Houston, TX 77030-1501
Mailing address
1414 N Shepherd Dr Apt 401
Houston, TX 77008-4092
Phone (724) 396-6066
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 |
|---|---|---|---|---|
| I20260224002283 | TX | Order and Referring Only - Nurse Practitioner | 0446731822 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1096254 | TX | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665360000000",
"number": "1265157440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 N SHEPHERD DR APT 401",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770084092",
"telephone_number": "724-396-6066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6411 FANNIN ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770301501",
"telephone_number": "713-704-6576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWEILER",
"first_name": "NICOLE",
"middle_name": "KAY",
"credential": "APRN-CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-10",
"last_updated": "2022-10-10",
"certification_date": "2022-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TX",
"license": "1096254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.