Individual provider Active NPI

Callie Nicole Dunn, PA-C

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1326505629
Registry record updated Feb 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12480 Issued in TX
Practice address
7777 Forest LN Ste C840
Dallas, TX 75230-2594
Phone
(972) 566-7000
NPI assigned
Feb 23, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA12480 TX Primary

Addresses

Primary practice location

7777 Forest LN Ste C840
Dallas, TX 75230-2594

Mailing address

3732 Fiscal CT
Fort Worth, TX 76244-8167
Phone (903) 243-3393

Other names 1

  • Callie Nicole Dennis Former name

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
I20190514002079 TX Practitioner - Physician Assistant 7416290499 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA12480TXMDPhysician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550880000000",
    "number": "1326505629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3732 FISCAL CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762448167",
            "telephone_number": "903-243-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE C840",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302594",
            "telephone_number": "972-566-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNN",
        "first_name": "CALLIE",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-23",
        "last_updated": "2019-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CALLIE",
            "last_name": "DENNIS",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.