Organization Active NPI

Safenerve PLLC

  • Electrodiagnostic Medicine Physician
  • Ft Worth, TX
National Provider Identifier
1629989793
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X
Legal business name
SAFENERVE PLLC
Practice address
4455 Camp Bowie Blvd # 114-67
Ft Worth, TX 76107-3826
Phone
(817) 529-8488
NPI assigned
Sep 16, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Electrodiagnostic Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204R00000X 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

NPI Registry JSON

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

{
    "created_epoch": "1789516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789516800000",
    "number": "1629989793",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFENERVE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-16",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "903-259-0550"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.