Individual provider Active NPI

Paola Mwenentanda, NP

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1285506295
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1205029 Issued in TX
Practice address
700 Olympic Plaza Cir Ste 700
Tyler, TX 75701-1954
Phone
(903) 262-3900
Fax
(903) 262-3993
NPI assigned
Sep 19, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1205029 TX Primary

Addresses

Primary practice location

700 Olympic Plaza Cir Ste 700
Tyler, TX 75701-1954

Mailing address

700 Olympic Plaza Cir Ste 700
Tyler, TX 75701-1954
Phone (903) 262-3900

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
I20251201002833 TX Practitioner - Nurse Practitioner 3577056381 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

Hospital & facility affiliations

  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1205029TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Nov 1, 2025 Accepting new patients
Etmc Physician Group Inc. CurrentSince Nov 1, 2025 Accepting new patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince Mar 1, 2026 Accepting new patients
University of Texas Health Science Center at Tyler-Facility-Physician CurrentSince Mar 1, 2026 Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

700 Olympic Plaza Cir
Ste 700
Tyler, TX 75701
Phone (903) 262-3900

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1758240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1285506295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 700",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011954",
            "telephone_number": "903-262-3900",
            "fax_number": "903-262-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 700",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011954",
            "telephone_number": "903-262-3900",
            "fax_number": "903-262-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MWENENTANDA",
        "first_name": "PAOLA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-19",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1205029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.