Active NPI
Jimmie Dwayne Fedrick, LMSW
- Social Worker
- Temple, TX
National Provider Identifier
1750766408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 60729
- Practice address
- 1901 Veterans Memorial Dr
Building #215; Room 121
Temple, TX 76504-7451 - Phone
- (254) 743-1647
- NPI assigned
- Jul 23, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 60729 | TX | Primary |
Addresses
Primary practice location
1901 Veterans Memorial Dr
Building #215; Room 121
Temple, TX 76504-7451
Mailing address
1901 Veterans Memorial Dr
Building #215; Room 121
Temple, TX 76504-7451
Phone (254) 743-1647
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 |
|---|---|---|---|
| 60729 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1750766408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 VETERANS MEMORIAL DR",
"address_2": "BUILDING #215; ROOM 121",
"city": "TEMPLE",
"state": "TX",
"postal_code": "765047451",
"telephone_number": "254-743-1647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 VETERANS MEMORIAL DR",
"address_2": "BUILDING #215; ROOM 121",
"city": "TEMPLE",
"state": "TX",
"postal_code": "765047451",
"telephone_number": "254-743-1647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDRICK",
"first_name": "JIMMIE",
"middle_name": "DWAYNE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-23",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "60729",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Temple, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.