Individual provider Active NPI

Melissa Kujawski, NP-C

  • Nurse Practitioner
  • Grapevine, TX
National Provider Identifier
1376140954
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1016154 Issued in TX
Practice address
1604 Lancaster Dr
Grapevine, TX 76051-3544
Phone
(855) 893-5637
Fax
(817) 666-3873
NPI assigned
Oct 6, 2020
Last updated
Nov 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1016154 TX Primary
Adult Health Nurse Practitioner 363LA2200X 1016154 TX
Gerontology Nurse Practitioner 363LG0600X 1016154 TX
Primary Care Nurse Practitioner 363LP2300X 1016154 TX

Addresses

Primary practice location

1604 Lancaster Dr
Grapevine, TX 76051-3544

Mailing address

332 Enid Dr
Lewisville, TX 75056-5874

Other practice location 1

2204 Wilborn Ave
South Boston, VA 24592-1645
Phone (214) 494-0520

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
I20210712001441 TX Practitioner - Nurse Practitioner 1759791718 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1016154TXMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Aug 1, 2022 Accepting new patients
Little Lantern Clinic LLC CurrentSince Jun 1, 2021 Accepting new patients
Theoria Medical Nurse Practitioner CurrentSince Sep 9, 2021 Accepting new patients
Healthtexas Provider Network Current Accepting new patients
Healthtexas Provider Network CurrentSince Aug 1, 2022 Accepting new patients

Locations

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

4541 N Josey Ln
Ste 110
Carrollton, TX 75010
Phone (469) 775-9555

3417 Gaston Ave
Ste 1100
Dallas, TX 75246
Phone (469) 800-9000

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

9 Medical Pkwy
Ste 210
Farmers Branch, TX 75234
Phone (214) 449-6511

3737 N Garland Ave
Garland, TX 75040
Phone (214) 315-6310

Interoperability endpoints

  • Direct secure messaging: melissa.kujawski@241432503910404.direct.elationemr.com

Organizations & group practices 5

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": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1376140954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 ENID DR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750565874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 LANCASTER DR",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513544",
            "telephone_number": "855-893-5637",
            "fax_number": "817-666-3873"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2204 Wilborn Ave",
            "address_purpose": "LOCATION",
            "city": "South Boston",
            "state": "VA",
            "postal_code": "245921645",
            "country_code": "US",
            "telephone_number": "214-494-0520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUJAWSKI",
        "first_name": "MELISSA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-06",
        "last_updated": "2023-11-14",
        "certification_date": "2023-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1016154",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "1016154",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1016154",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "1016154",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.