Organization Active NPI

Heart and Soul Medical PA

  • Primary Care Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1336975903
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
HEART AND SOUL MEDICAL PA
Practice address
600 W 6TH St Ste 455
Fort Worth, TX 76102-3684
Phone
(949) 322-6878
NPI assigned
Sep 11, 2024
Last updated
Sep 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Authorized official

Name
Taylor Carol
Title
Authorized Official
Phone
(949) 322-6878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary

Addresses

Primary practice location

600 W 6TH St Ste 455
Fort Worth, TX 76102-3684

Mailing address

600 W 6TH St Ste 455
Fort Worth, TX 76102-3684
Phone (949) 322-6878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241226000770 TX Part B Supplier - Clinic/Group Practice 1153858568 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

600 W 6th St
Ste 455
Fort Worth, TX 76102
Phone (682) 428-7718

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1336975903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W 6TH ST STE 455",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761023684",
            "telephone_number": "949-322-6878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W 6TH ST STE 455",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761023684",
            "telephone_number": "949-322-6878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART AND SOUL MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "CAROL",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "949-322-6878"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.