Concepcion Fanous, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1197042 Issued in TX

Practice address

2737 S Broadway Ave
Tyler, TX 75701-5445

Phone

(903) 592-6000

Fax

(903) 592-3224

NPI assigned

Nov 9, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Connie Fanous Professional name

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charles R Gordon MD PAGroup PAC ID 8729992052, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

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

• Charles R Gordon MD PA

  dba Precision Spine Care

  • Neurological Surgery Physician
  • Tyler, TX
  • NPI 1982717955
  Medicare reassignment Care Compare group NPD
• Elias I Fanous Jr MD PA

  • Gastroenterology Physician
  • Tyler, TX
  • NPI 1982880647
  Medicare reassignment NPD
• Charles R Gordon MD PA

  dba Precision Spine Care

  • Interventional Pain Medicine Physician
  • Lufkin, TX
  • NPI 1720513328
  NPD

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

{
    "created_epoch": "1667952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776211200000",
    "number": "1366150260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6605",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757116605",
            "telephone_number": "903-592-6000",
            "fax_number": "903-592-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015445",
            "telephone_number": "903-592-6000",
            "fax_number": "903-592-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANOUS",
        "first_name": "CONCEPCION",
        "name_prefix": "Mrs.",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-09",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1197042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "FANOUS",
            "prefix": "MRS.",
            "credential": "APRN, FNP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Family First Pharmacy LP (Family First Pharmacy)
• Wayne Bradshaw Fancher III, DPT, PT
• Fannin County Hospital Authority (The Waterton Healthcare and Rehabilitation)
• Paul M Fanning, MD
• David Pearce Fannon, MPAS, PA-C
• Elias I Fanous Jr., MD
• Christian Paul Fant, RD
• Osama Ali Faridi, DO
• Joy 'Jackie' Farmer, M.ED
• Mary Farrar

• Family Nurse Practitioner in Tyler, TX
• Providers in Tyler, 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 Apr 15, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.