Gwendoline Keri Bongkishiy

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP143257 Issued in TX

Practice address

17606 Hanoverian Dr
Richmond, TX 77407-2716

Phone

(978) 660-7997

NPI assigned

Mar 11, 2021

Last updated

Sep 12, 2023By 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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1487239414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17606 HANOVERIAN DR",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774072716",
            "telephone_number": "978-660-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17606 HANOVERIAN DR",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774072716",
            "telephone_number": "978-660-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGKISHIY",
        "first_name": "GWENDOLINE",
        "middle_name": "KERI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP143257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Richmond, TX
• Providers in Richmond, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; 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.