Charlene Devyn Anderson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1015157 Issued in TX

Practice address

111 Dallas St
San Antonio, TX 78205-1201

Phone

(210) 297-7000

NPI assigned

Oct 12, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863
  Medicare reassignment NPD
• Vpa of Texas PLLC

  • Family Medicine Physician
  • Irving, TX
  • NPI 1679510499
  Medicare reassignment NPD
• Vpa of Texas PLLC

  • Clinical Social Worker
  • San Antonio, TX
  • NPI 1578175865
  NPD

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

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1366040487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8631 KEY NORTH WAY",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781093681",
            "telephone_number": "210-216-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DALLAS ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782051201",
            "telephone_number": "210-297-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "CHARLENE",
        "middle_name": "DEVYN",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1015157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Taylor Anderson, DPT
• Barbara Dianne Anderson, R.N.
• Bradford James Anderson, APRN, AGACNP-BC
• Brittney M Anderson, LPC
• Carla Anderson
• Christian Anderson
• Christin Ruth Anderson
• Clark Calvin Anderson, MD
• Clint Kelley Anderson, MD
• Crystal Anderson

• Family Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.