Glen Eldon Tullous III, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1023704 Issued in TX

Practice address

1001 12TH Ave Ste 102
Fort Worth, TX 76104-3926

Phone

(817) 725-7880

NPI assigned

May 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PPG Health PAGroup PAC ID 7113904657, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Huguley Hospital Fort Worth South Hospital, Fort Worth, TX, CCN 450677

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• PPG Health, PA

  dba Longevity Bariatric and Wellness

  • Nephrology Physician
  • Fort Worth, TX
  • NPI 1295736973
  Medicare reassignment Care Compare group NPD
• Ai Interventional LLC

  dba Knee and Vein Vascular Centers

  • Vascular & Interventional Radiology Physician
  • Irving, TX
  • NPI 1023983210
  NPD (past)

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

• Texas Health Huguley, Inc

  dba Texas Health Huguley Hospital Fort Worth South

  • Psychiatric Hospital Unit
  • Burleson, TX
  • NPI 1518355759
  Care Compare affiliation
• Texas Health Huguley, Inc.

  dba Texas Health Huguley Hospital Fort Worth South

  • General Acute Care Hospital
  • Burleson, TX
  • NPI 1033120423
  Care Compare affiliation
• Texas Health Huguley, Inc.

  dba Huguley Memorial Medical Center

  • Psychiatric Hospital Unit
  • Burleson, TX
  • NPI 1548273881
  Care Compare affiliation

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1720652167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043029",
            "telephone_number": "817-725-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE STE 102",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043926",
            "telephone_number": "817-725-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLOUS",
        "first_name": "GLEN",
        "middle_name": "ELDON",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1023704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Tucker, LPC
• Vicki J Tucker, CRNA
• Michelle Pacee Tuggle, LCDC
• Diana Tuitai
• Ashley Tullier, OT
• Michael Tuma, LPC, LCDC
• Tumble Authority Physical Therapy (West DFW Physical Therapy)
• Rajachendra Shekher Tumma, M.D.
• Gayane Tumyan, MD
• Aaron Wood Tungate, P.A.

• Family Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; 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.