NPIMap

Individual provider Active NPI

Thomas Fomukong

  • Licensed Practical Nurse
  • Garland, TX
National Provider Identifier
1588078703
Registry record updated Jun 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
311971 Issued in TX
Practice address
2433 Goldfinch LN
Garland, TX 75042-8022
Phone
(972) 272-5820
NPI assigned
Jun 16, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 311971 TX Primary

Addresses

Primary practice location

2433 Goldfinch LN
Garland, TX 75042-8022

Mailing address

2433 Goldfinch LN
Garland, TX 75042-8022
Phone (972) 272-5820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
311971TXMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Medical Supplies and Rehabilitation Network Past Accepting new patients
Bah Career Training Inc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402876800000",
    "number": "1588078703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2433 GOLDFINCH LN",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750428022",
            "telephone_number": "972-272-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2433 GOLDFINCH LN",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750428022",
            "telephone_number": "972-272-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMUKONG",
        "first_name": "THOMAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-16",
        "last_updated": "2014-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TX",
            "license": "311971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; 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.