Individual provider Active NPI

Stefeena Rachel Pothen, FNP-C

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1346092749
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1139006 Issued in TX
Practice address
700 N Pearl St Ste N208
Dallas, TX 75201-7430
Phone
(214) 999-9355
Fax
(214) 999-9363
NPI assigned
Apr 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1139006 TX Primary

Addresses

Primary practice location

700 N Pearl St Ste N208
Dallas, TX 75201-7430

Mailing address

700 N Pearl St Ste N208
Dallas, TX 75201-7430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20260516000595 OK Practitioner - Nurse Practitioner 1557830726 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

10802 Quail Plaza Dr
Suite 112
Oklahoma City, OK 73120-3116

9400 NW 86TH St
Yukon, OK 73099-9310

PO Box
Suite 268953
Oklahoma City, OK 73126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1139006TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
QS Peds Med LLC PastSince Jun 26, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: stefeena.pothen.1@29732.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1346092749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N PEARL ST STE N208",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752017430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N PEARL ST STE N208",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752017430",
            "telephone_number": "214-999-9355",
            "fax_number": "214-999-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTHEN",
        "first_name": "STEFEENA",
        "middle_name": "RACHEL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1139006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.