Tia Roche Ivory, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP136828 Issued in TX

Practice address

2019A S Henderson Blvd Ste 2
Kilgore, TX 75662-3567

Phone

(903) 483-7707

Fax

(903) 483-7708

NPI assigned

Mar 3, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Marshall Family Practice Associates PLLC

  • Preferred Provider Organization
  • Marshall, TX
  • NPI 1528070414

  TX

  Medicare reassignment NPD

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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

{
    "created_epoch": "1520035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1689176885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019A SOUTH HENDERSON BLVD, SUITE 2",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756623915",
            "telephone_number": "903-483-7707",
            "fax_number": "903-483-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019A S HENDERSON BLVD STE 2",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756623567",
            "telephone_number": "903-483-7707",
            "fax_number": "903-483-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVORY",
        "first_name": "TIA",
        "middle_name": "ROCHE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-03",
        "last_updated": "2023-05-08",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP136828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "8025511",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Kay Hinch, PTA
• Hospice of Hope LLC
• Linda Louise Hughes, LCDC
• Heather R Hutchison, MS, RD, LD
• Insight Eye Care, PLLC
• Tashata Re'Kal Jackson, COTA
• Ashley Johnson
• Katrina Denean Johnson, C.O.T.A.
• Kevin Charles Johnson, PHARM. D.
• Jack Johnston, DDS

• All providers in Kilgore, TX
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.