Dyvette L Warren, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA03155 Issued in TX

Practice address

179 Interstate 45 S
Suite 300
Huntsville, TX 77340-4223

Phone

(936) 294-0152

Fax

(936) 294-9600

NPI assigned

May 19, 2010

Last updated

May 19, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• PCP for Life PA

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1497071955
  Medicare reassignment
• Burhani Surgical LTD PLLC

  dba Lone Star Surgical Solutions

  • Surgery Physician
  • Houston, TX
  • NPI 1811520737
  NPD (past)

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274227200000",
    "number": "1477872190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 INTERSTATE 45 S",
            "address_2": "SUITE 300",
            "city": "HUNTSVILLE",
            "state": "TX",
            "postal_code": "773404223",
            "telephone_number": "936-294-0152",
            "fax_number": "936-294-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 INTERSTATE 45 S",
            "address_2": "SUITE 300",
            "city": "HUNTSVILLE",
            "state": "TX",
            "postal_code": "773404223",
            "telephone_number": "936-294-0152",
            "fax_number": "936-294-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "DYVETTE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-19",
        "last_updated": "2010-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA03155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Levi Wallace, FNP-C
• Katie Waller, LCDC
• Sonja Lynne Walls
• John Q Wang, PAC
• Jesse Scott Ward, M.D.
• Lilian Judy Wangari Warren, NEMT
• Anil Warrier, M.D.
• Andrea Watkins
• Yolunda Weatherspoon Nolen, FNP-BC
• Joseph Weber, DMD

• Medical Physician Assistant in Huntsville, TX
• Providers in Huntsville, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.