Active NPI
Medea Mohseni
- Dentist
- Wichita Falls, TX
National Provider Identifier
1699451633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 39630
- Practice address
- 2515 E Elliott St
Wichita Falls, TX 76308-3708 - Phone
- (940) 696-9701
- NPI assigned
- Jun 26, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 39630 | TX | Primary |
Addresses
Primary practice location
2515 E Elliott St
Wichita Falls, TX 76308-3708
Mailing address
22 Fleet St NW Apt H22
Fort Walton Beach, FL 32548-3821
Phone (408) 368-5747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39630 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glendaly Fernandez, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Wichita Falls, TX
- NPI 1629420666
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687737600000",
"number": "1699451633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 FLEET ST NW APT H22",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325483821",
"telephone_number": "408-368-5747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2515 E ELLIOTT ST",
"city": "WICHITA FALLS",
"state": "TX",
"postal_code": "763083708",
"telephone_number": "940-696-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHSENI",
"first_name": "MEDEA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-26",
"last_updated": "2023-06-26",
"certification_date": "2023-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "39630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita Falls, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.