Individual provider Active NPI

Emiko N Dudley, PNP

  • Pediatric Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1619342409
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP129237 Issued in TX
Practice address
903 W Martin St
San Antonio, TX 78207-0903
Phone
(210) 358-5437
Fax
(210) 358-5476
NPI assigned
Dec 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP129237 TX
Pediatric Nurse Practitioner 363LP0200X AP129237 TX Primary

Addresses

Primary practice location

903 W Martin St
San Antonio, TX 78207-0903

Mailing address

903 W Martin St
San Antonio, TX 78207-0903
Phone (210) 358-5437

Other practice location 1

4502 Medical Dr
San Antonio, TX 78229-4402
Phone (210) 358-3436

Other identifiers 2

IdentifierTypeStateIssuer
355320803OtherTXCSHCN
355320802MedicaidTX

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
I20160120000547 TX Practitioner - Nurse Practitioner 1759684012 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

903 W Martin St
San Antonio, TX 78207-0903
Phone (210) 358-3400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP129237TXMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Health Science Center at San Antonio CurrentSince Jun 1, 2019 Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince Jun 1, 2019 Accepting new patients
Community Medicine Associates Nurse Practitioner CurrentSince Nov 7, 2015 Accepting new patients

Locations

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

903 W Martin St
San Antonio, TX 78207
Phone (210) 358-3400

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

4502 Medical Dr
Fl 3
San Antonio, TX 78229
Phone (210) 358-0770

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1619342409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 W MARTIN ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782070903",
            "telephone_number": "210-358-5437",
            "fax_number": "210-358-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 W MARTIN ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782070903",
            "telephone_number": "210-358-5437",
            "fax_number": "210-358-5476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4502 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294402",
            "country_code": "US",
            "telephone_number": "210-358-3436",
            "fax_number": "210-702-4567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "EMIKO",
        "middle_name": "N",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-06",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP129237",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP129237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "355320803",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355320802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.