Tim Senthavisouk, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

775309 Issued in TX

Practice address

4800 Fredericksburg Rd
Suite 127
San Antonio, TX 78229-3628

Phone

(210) 733-5072

Fax

(210) 733-8649

NPI assigned

Oct 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1376731885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1239",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480991239",
            "telephone_number": "248-824-6600",
            "fax_number": "248-324-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 FREDERICKSBURG RD",
            "address_2": "SUITE 127",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293628",
            "telephone_number": "210-733-5072",
            "fax_number": "210-733-8649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SENTHAVISOUK",
        "first_name": "TIM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "775309",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP 16316",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "775309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0930196740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.