Individual provider Active NPI

Victoria Agudah, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Arlington, TX
National Provider Identifier
1730647991
Registry record updated Aug 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP140032 Issued in TX
Practice address
4621 S Cooper St Ste 131-657
Arlington, TX 76017-5866
Phone
(817) 899-8856
NPI assigned
Mar 6, 2019
Last updated
Aug 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP140032 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP140032 TX Primary

Addresses

Primary practice location

4621 S Cooper St Ste 131-657
Arlington, TX 76017-5866

Mailing address

4621 S Cooper St Ste 131-657
Arlington, TX 76017-5866
Phone (817) 899-8856

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240711002441 CA Practitioner - Nurse Practitioner 2365873544 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95026136CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Mellow Medical Inc a Professional Corporation Single Specialty CurrentSince Mar 3, 2026 Accepting new patients
Brightside Medical, P.C. Single Specialty Past Accepting new patients

Locations

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (888) 284-2779

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4
  • Direct secure messaging: victoria.agudah.1@9357.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787270400000",
    "number": "1730647991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4621 S COOPER ST STE 131-657",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760175866",
            "telephone_number": "817-899-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4621 S COOPER ST STE 131-657",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760175866",
            "telephone_number": "817-899-8856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUDAH",
        "first_name": "VICTORIA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-06",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP140032",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP140032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.