NPIMap

Organization Active NPI

Royal Haven Medical

  • Primary Care Nurse Practitioner
  • Mansfield, TX
National Provider Identifier
1740895911
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
ROYAL HAVEN MEDICAL
Practice address
2384 Highway 287 N Ste 216
Mansfield, TX 76063-9207
Phone
(817) 400-0433
Fax
(817) 415-6595
NPI assigned
Sep 14, 2020
Last updated
Jun 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Paidamoyo WagonekaNPI 1700391257
Title
Owner
Phone
(817) 400-0433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X Primary

Addresses

Primary practice location

2384 Highway 287 N Ste 216
Mansfield, TX 76063-9207

Mailing address

2384 Highway 287 N Ste 216
Mansfield, TX 76063-9207
Phone (817) 400-0433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200929001498 TX Part B Supplier - Clinic/Group Practice 4284053026 Receives reassigned benefits from 8 practitioners
Practice locations: Mansfield, TX

National Provider Directory

National Provider Directory

Locations

2384 Highway 287 N
Ste 216
Mansfield, TX 76063
Phone (682) 400-8577

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1740895911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2384 HIGHWAY 287 N STE 216",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760639207",
            "telephone_number": "817-400-0433",
            "fax_number": "817-415-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2384 HIGHWAY 287 N STE 216",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760639207",
            "telephone_number": "817-400-0433",
            "fax_number": "817-415-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYAL HAVEN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-14",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "WAGONEKA",
        "authorized_official_first_name": "PAIDAMOYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-400-0433"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.