Individual provider Active NPI

Dolly Nyarera Nyamichaba

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1467144188
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1121341 Issued in TX
Practice address
6200 Overton Ridge Blvd
Fort Worth, TX 76132-3614
Phone
(817) 361-1991
NPI assigned
May 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1121341 TX Primary

Addresses

Primary practice location

6200 Overton Ridge Blvd
Fort Worth, TX 76132-3614

Mailing address

713 Manchester Dr
Mansfield, TX 76063-2894

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
I20241115001237 TX Practitioner - Nurse Practitioner 6901330752 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Senior Psychcare of Dallas I PLLCGroup PAC ID 2466625371, 46 clinicians

Practice addresses (Care Compare)

1402 E Broad St
Mansfield Nursing and Rehabilitation LP
Mansfield, TX 76063-1806
Phone (817) 477-2176

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1121341TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Psychcare of Dallas I, PLLC Psychiatric/Mental Health CurrentSince Nov 4, 2024 Accepting new patients
Vital Housecall LLC CurrentSince Nov 1, 2024 Accepting new patients
Desoto Healthcare Clinic LLC CurrentSince Nov 1, 2024 Accepting new patients
Happy Bridge Primary Care & Home Health PLLC PastSince Nov 6, 2025 Accepting new patients

Locations

1900 Oneal St
Gainesville, TX 76240
Phone (940) 665-2826

4635 Southwest Fwy
Ste 635
Houston, TX 77027
Phone (214) 923-7777

1221 W Airport Fwy
Ste 209
Irving, TX 75062
Phone (214) 455-5028

860 Hebron Pkwy
Ste 704
Lewisville, TX 75057
Phone (214) 777-2703

1402 E Broad St
Mansfield, TX 76063
Phone (817) 477-2176

4200 Shepherd Ln
Mesquite, TX 75180
Phone (972) 286-0335

7146 Baker Blvd
Richland Hills, TX 76118
Phone (817) 589-1734

Organizations & group practices 4

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": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1467144188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 MANCHESTER DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761323614",
            "telephone_number": "817-361-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYAMICHABA",
        "first_name": "DOLLY",
        "middle_name": "NYARERA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1121341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.