Active NPI
Kendra L McNellye-Mattox, RN, DFNP-BC
- Family Nurse Practitioner
- El Paso, TX
National Provider Identifier
1295712776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP124124
- Practice address
- 8061 Alameda Ave
El Paso, TX 79915-4705 - Phone
- (915) 351-8972
- Fax
- (915) 351-6033
- NPI assigned
- Dec 27, 2005
- 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 | AP124124 | TX | Primary |
Addresses
Primary practice location
8061 Alameda Ave
El Paso, TX 79915-4705
Mailing address
8061 Alameda Ave
El Paso, TX 79915-4705
Phone (915) 351-8972
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000487073 | Other | IN | BLUE SHIELD |
| P00301672 | Other | IN | RR MEDICARE |
| 83625739 | Medicaid | NM | |
| F1104136 | Other | AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION # | |
| 200491110 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Health Services, Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Hartford City, IN
- NPI 1245094028
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437696000000",
"number": "1295712776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8061 ALAMEDA AVE",
"city": "EL PASO",
"state": "TX",
"postal_code": "799154705",
"telephone_number": "915-351-8972",
"fax_number": "915-351-6033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8061 ALAMEDA AVE",
"city": "EL PASO",
"state": "TX",
"postal_code": "799154705",
"telephone_number": "915-351-8972",
"fax_number": "915-351-6033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNELLYE-MATTOX",
"first_name": "KENDRA",
"middle_name": "L",
"credential": "RN, DFNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-27",
"last_updated": "2015-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP124124",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000000487073",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00301672",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "83625739",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION #",
"identifier": "F1104136",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200491110",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.