Individual provider Active NPI

Renee Miphouvieng, FNP

  • Family Nurse Practitioner
  • Keller, TX
National Provider Identifier
1437541588
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP127282 Issued in TX
Practice address
100 Bourland Rd Ste 150
Keller, TX 76248-3595
Phone
(817) 753-6250
Fax
(817) 431-1441
NPI assigned
Feb 26, 2015
Last updated
Dec 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP127282 TX Primary

Addresses

Primary practice location

100 Bourland Rd Ste 150
Keller, TX 76248-3595

Mailing address

100 Bourland Rd Ste 150
Keller, TX 76248-3595
Phone (817) 753-6250

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
I20160205001185 TX Practitioner - Nurse Practitioner 2466756812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

100 Bourland Rd
Suite 150
Keller, TX 76248-3595
Phone (817) 753-6250

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP127282TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group CurrentSince Jun 1, 2016 Accepting new patients
Texas Health Physicians Group CurrentSince Jun 1, 2016 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

100 Bourland Rd
Ste 150
Keller, TX 76248
Phone (817) 753-6250

100 Bourland Rd
Ste 170
Keller, TX 76248
Phone (817) 741-2001

Interoperability endpoints

  • Direct secure messaging: rmiphouvieng3360@direct.texashealth.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1437541588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BOURLAND RD STE 150",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483595",
            "telephone_number": "817-753-6250",
            "fax_number": "817-431-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BOURLAND RD STE 150",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483595",
            "telephone_number": "817-753-6250",
            "fax_number": "817-431-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIPHOUVIENG",
        "first_name": "RENEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-26",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP127282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keller, TX

Sources for this page

Verify at the official NPI Registry.