Organization Active NPI

Nervana Ionm PLLC

  • Electroneurodiagnostic Specialist/Technologist
  • Fort Worth, TX
National Provider Identifier
1609711373
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X
Legal business name
NERVANA IONM PLLC
Practice address
4455 Camp Bowie Blvd # 114-67
Ft Worth, TX 76107-3826
Phone
(817) 529-8488
Fax
(903) 328-6568
NPI assigned
Apr 21, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Authorized official

Name
Gina Sullivan
Title
Practice Administrator
Phone
(903) 259-0550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Electroneurodiagnostic Specialist/TechnologistGroup: 193400000X SINGLE SPECIALTY GROUP 246ZE0600X Primary

Addresses

Primary practice location

4455 Camp Bowie Blvd # 114-67
Ft Worth, TX 76107-3826

Mailing address

4455 Camp Bowie Blvd # 114-67
Ft Worth, TX 76107-3826
Phone (817) 529-8488

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1609711373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 CAMP BOWIE BLVD # 114-67",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761073826",
            "telephone_number": "817-529-8488",
            "fax_number": "903-328-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 CAMP BOWIE BLVD # 114-67",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761073826",
            "telephone_number": "817-529-8488",
            "fax_number": "903-328-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NERVANA IONM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "903-259-0550"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; 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.