Active NPI
Pediaq
- Pediatric Nurse Practitioner
- Dallas, TX
National Provider Identifier
1477938132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- Legal business name
- PEDIAQ
- Practice address
- 17101 Preston Rd
Ste 115
Dallas, TX 75248-1331 - Phone
- (214) 984-3900
- Fax
- (972) 294-3343
- NPI assigned
- Jul 23, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Frederick Johnson, DO
- Title
- Medical Director
- Phone
- (214) 984-3900
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | Primary |
Addresses
Primary practice location
17101 Preston Rd
Ste 115
Dallas, TX 75248-1331
Mailing address
17101 Preston Rd
Ste 115
Dallas, TX 75248-1331
Phone (214) 984-3900
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1437609600000",
"number": "1477938132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17101 PRESTON RD",
"address_2": "STE 115",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481331",
"telephone_number": "214-984-3900",
"fax_number": "972-294-3343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17101 PRESTON RD",
"address_2": "STE 115",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481331",
"telephone_number": "214-984-3900",
"fax_number": "972-294-3343"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDIAQ",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-23",
"last_updated": "2015-07-23",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "FREDERICK",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "214-984-3900",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
- Rebecca Pedersen, MD
- Jamie Pederson, LCSW
- Pedi-Ortho Health Corporation
- Pediacare of Texas Inc
- Pediapex Heart Center for Children PA
- Pediaq Texas LLC
- Pediatric Acute Care Associates of N.TX, PLLC
- Pediatric Acute Care Associates of North Texas, PLLC
- Pediatric Allergy Immunology Assoc.,P.a.
- Pediatric Anesthesia Associates
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.