Active NPI
Jordyn Ghanem, FNP-C
- Family Nurse Practitioner
- Dallas, TX
National Provider Identifier
1285439760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1179049
- Practice address
- 17110 Dallas Pkwy Ste 100
Dallas, TX 75248-1167 - Phone
- (972) 380-7090
- NPI assigned
- Feb 18, 2025
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1179049 | TX | Primary |
Addresses
Primary practice location
17110 Dallas Pkwy Ste 100
Dallas, TX 75248-1167
Mailing address
5050 Capitol Ave Apt 107
Dallas, TX 75206-6920
Phone (561) 856-1310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 9, 2025 through May 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1179049 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739836800000",
"number": "1285439760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5050 CAPITOL AVE APT 107",
"city": "DALLAS",
"state": "TX",
"postal_code": "752066920",
"telephone_number": "561-856-1310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17110 DALLAS PKWY STE 100",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481167",
"telephone_number": "972-380-7090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANEM",
"first_name": "JORDYN",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-18",
"last_updated": "2025-02-18",
"certification_date": "2025-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "1179049",
"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 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.