Manga Telidevara, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1090732 Issued in TX

Practice address

615 Worsham St
Montgomery, TX 77316-4497

Phone

(281) 650-0945

NPI assigned

Aug 24, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• P3 Medical Group PC

  • Family Medicine Physician
  • Salem, OR
  • NPI 1689266926

  Nurse Practitioner

  Medicare reassignment NPD
• Angels of Ark, LLC

  • Nurse Practitioner
  • Medford, OR
  • NPI 1285512798
  NPD Authorized official
• Well Spring Health LLC

  • Gerontology Nurse Practitioner
  • Medford, OR
  • NPI 1417581315
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Care Compare affiliation

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1497474373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 WORSHAM ST",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773164497",
            "telephone_number": "281-650-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 WORSHAM ST",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773164497",
            "telephone_number": "281-650-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELIDEVARA",
        "first_name": "MANGA",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1090732",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1090732",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Reynolds Tague, LCSW
• Evelyn Tamakloe
• Connie Tatroe, LMT
• Lisa Diane Taylor, PA-C
• Ruth N Taylor, PT
• Tens RX, Inc.
• Sharon Veronica Terry, RN
• Texas Dental Sleep Services PLLC
• Texas Home Sleep LLC
• Texas Rapidrad Imaging LLC

• Family Nurse Practitioner in Montgomery, TX
• Providers in Montgomery, 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 Dec 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.