Araceli Theodore

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP131527 Issued in TX

Practice address

632 Broadway PH 12
New York, NY 10012-2614

Phone

(347) 294-3414

Fax

(205) 332-1383

NPI assigned

Aug 16, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Greater Dallas Healthcare Enterprises

  • Obstetrics & Gynecology Physician
  • Dallas, TX
  • NPI 1255542122
  NPD (past)

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

{
    "created_epoch": "1471305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1548715923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 BROADWAY PH 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100122614",
            "telephone_number": "347-294-3414",
            "fax_number": "205-332-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 BROADWAY PH 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100122614",
            "telephone_number": "347-294-3414",
            "fax_number": "205-332-1383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4704 Montrose Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770066122",
            "country_code": "US",
            "telephone_number": "713-333-0151",
            "fax_number": "832-485-5080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 St Joseph Pkwy Ste 1205",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770028235",
            "country_code": "US",
            "telephone_number": "713-659-3937",
            "fax_number": "713-659-2553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEODORE",
        "first_name": "ARACELI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-16",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX1100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ophthalmic",
            "state": "TX",
            "license": "AP131527",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP131527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sthefanie Then, LMSW
• Theo E. Obrig, Inc.
• Theodore Diktaban, MD PLLC
• Theodore Tyberg MD
• Theodore W Lieberman MD PC
• Deborah Anne Theodore
• John L. Theodore, PH.D.
• Mary Eugenia Theodore, MD MPH
• Nicole Theodore, LMSW
• Sathya Theodore, M.D.

• Gerontology Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Gerontology Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.