Individual provider Active NPI

Ciara Yun

  • Family Nurse Practitioner
  • Houston, TX
National Provider Identifier
1558974360
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP145686 Issued in TX
Practice address
12605 East Fwy Ste 510
Houston, TX 77015-5623
Phone
(281) 713-4535
NPI assigned
Aug 31, 2020
Last updated
Oct 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP145686 TX Primary

Addresses

Primary practice location

12605 East Fwy Ste 510
Houston, TX 77015-5623

Mailing address

6846 Antoine Dr
Houston, TX 77091-1210
Phone (713) 510-7122

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20201203002564 TX Practitioner - Nurse Practitioner 9931510435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3430 Ctr St
Deer Park, TX 77536-5056
Phone (281) 628-2040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP145686TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Community Health Services, Inc CurrentSince Nov 6, 2024 Accepting new patients
Legacy Community Health Services, Inc Single Specialty CurrentSince Nov 6, 2024 Accepting new patients
360 Therapy & Psychological Services, LLC Single Specialty Past Accepting new patients

Locations

4301 Garth Rd
Ste 400
Baytown, TX 77521
Phone (281) 420-8400

3430 Center St
Deer Park, TX 77536
Phone (832) 266-7303

1415 California St
Houston, TX 77006
Phone (713) 665-8800

3811 Lyons Ave
Houston, TX 77020
Phone (713) 814-3605

5420 Dashwood Dr
Ste 100
Houston, TX 77081
Phone (713) 486-2900

6441 High Star Dr
Houston, TX 77074
Phone (832) 548-5300

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1558974360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6846 ANTOINE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770911210",
            "telephone_number": "713-510-7122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12605 EAST FWY STE 510",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770155623",
            "telephone_number": "281-713-4535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUN",
        "first_name": "CIARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP145686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.