Individual provider Active NPI

Olivia Nora Meserole, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1619605383
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15938 Issued in TX
Practice address
815 Pennsylvania Ave
Fort Worth, TX 76104-2294
Phone
(817) 321-0404
NPI assigned
Aug 10, 2022
Last updated
May 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA15938 TX Primary
Medical Physician Assistant 363AM0700X NU
Medical Physician Assistant 363AM0700X PA15938 TX

Addresses

Primary practice location

815 Pennsylvania Ave
Fort Worth, TX 76104-2294

Mailing address

1320 S University Dr Ste 500
Fort Worth, TX 76107-5732
Phone (817) 321-0404

Other practice location 1

603 10th St
Galveston, TX 77550-5113
Phone (815) 721-7856

Other practice location 2

3166 S State Highway 161 Ste 170
Grand Prairie, TX 75052-7720
Phone (972) 640-0005

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
I20250326001898 TX Practitioner - Physician Assistant 5698298073 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

17980 Dallas Pkwy
Suite 200
Dallas, TX 75287-6817
Phone (817) 321-0937

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates of North Texas PA CurrentSince May 12, 2025 Accepting new patients
Radiology Associates of North Texas PA CurrentSince May 12, 2025 Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

7777 Forest Ln
Dallas, TX 75230
Phone (972) 566-7283

1320 S University Dr
Ste 500
Fort Worth, TX 76107
Phone (817) 321-0391

1622 8th Ave
Ste 120
Fort Worth, TX 76104
Phone (817) 923-8220

815 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 321-0300

1814 Roseland Blvd
Ste 100
Tyler, TX 75701
Phone (214) 696-8033

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1619605383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 S UNIVERSITY DR STE 500",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761075732",
            "telephone_number": "817-321-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042294",
            "telephone_number": "817-321-0404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "603 10th St",
            "address_purpose": "LOCATION",
            "city": "Galveston",
            "state": "TX",
            "postal_code": "775505113",
            "country_code": "US",
            "telephone_number": "815-721-7856",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3166 S State Highway 161 Ste 170",
            "address_purpose": "LOCATION",
            "city": "Grand Prairie",
            "state": "TX",
            "postal_code": "750527720",
            "country_code": "US",
            "telephone_number": "972-640-0005",
            "fax_number": "210-314-5044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MESEROLE",
        "first_name": "OLIVIA",
        "middle_name": "NORA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-10",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA15938",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA15938",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.