NPIMap

Individual provider Active NPI

Charlotte Irene Widick, ENP

  • Acute Care Nurse Practitioner
  • Marlin, TX
National Provider Identifier
1376581751
Registry record updated Mar 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
575896 Issued in TX
Practice address
322 Coleman St
Marlin, TX 76661-2358
Phone
(254) 803-3561
NPI assigned
Jun 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 575896 TX Primary

Addresses

Primary practice location

322 Coleman St
Marlin, TX 76661-2358

Mailing address

4250 S Highway 281
Blanco, TX 78606
Phone (830) 833-0510

Other identifiers 1

IdentifierTypeStateIssuer
117953308MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Oct 1, 2024 through Oct 1, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
575896TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Southeast Emergency Physicians, LLP Past Accepting new patients
Memorial Southwest Emergency Physicians, LLP Past Accepting new patients
Brazos Emergency Physicians, PA Past Accepting new patients
Total Inpatient Services, PA Past Accepting new patients
Stat Care of Texas, PA Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206489600000",
    "number": "1376581751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 S HIGHWAY 281",
            "city": "BLANCO",
            "state": "TX",
            "postal_code": "78606",
            "telephone_number": "830-833-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 COLEMAN ST",
            "city": "MARLIN",
            "state": "TX",
            "postal_code": "766612358",
            "telephone_number": "254-803-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDICK",
        "first_name": "CHARLOTTE",
        "middle_name": "IRENE",
        "credential": "ENP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2008-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "575896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117953308",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlin, TX

Sources for this page

Verify at the official NPI Registry.