Individual provider Active NPI

Judith Kay Werner, D.O.

  • Family Medicine Physician
  • Mansfield, TX
National Provider Identifier
1467454355
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H2898 Issued in TX
Practice address
2800 E. Broad St.
Suite 508
Mansfield, TX 76063-6417
Phone
(817) 473-8791
Fax
(817) 473-7639
NPI assigned
Aug 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H2898 TX Primary

Addresses

Primary practice location

2800 E. Broad St.
Suite 508
Mansfield, TX 76063-6417

Mailing address

2800 E. Broad St.
Suite 508
Mansfield, TX 76063-6417
Phone (817) 473-8791

Other identifiers 1

IdentifierTypeStateIssuer
127982-004MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070428000029 TX Practitioner - Family Practice 0042316697 Practice locations: Mansfield, TX

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277251200000",
    "number": "1467454355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 E. BROAD ST.",
            "address_2": "SUITE 508",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760636417",
            "telephone_number": "817-473-8791",
            "fax_number": "817-473-7639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E. BROAD ST.",
            "address_2": "SUITE 508",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760636417",
            "telephone_number": "817-473-8791",
            "fax_number": "817-473-7639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERNER",
        "first_name": "JUDITH",
        "middle_name": "KAY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2010-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H2898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127982-004",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

Verify at the official NPI Registry.