Tara Jo Elizondo, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1107727 Issued in TX

Practice address

1522 W Frank Ave
Lufkin, TX 75904-3334

Phone

(936) 639-2384

Fax

(936) 639-9888

NPI assigned

Feb 2, 2023

Last updated

Feb 2, 2023By the provider in NPPES

Sex

Female

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Burke CenterGroup PAC ID 1254312077, 28 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Burke Center

  • Psychiatry Physician
  • Lufkin, TX
  • NPI 1396792420
  Medicare reassignment Care Compare group NPD
• Burke Center

  • Developmental Disabilities Clinic/Center
  • Lufkin, TX
  • NPI 1164572772
  NPD (past)

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

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1760188502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 W FRANK AVE",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043334",
            "telephone_number": "936-639-2384",
            "fax_number": "936-639-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 W FRANK AVE",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043334",
            "telephone_number": "936-639-2384",
            "fax_number": "936-639-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZONDO",
        "first_name": "TARA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-02",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1107727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Shane Edwards, D.D.S.
• Leanne Marie Ehlers-Anderson, R.D., L.D
• Element Dental PLLC (Element Dental & Orthodontics)
• Elite Hospice and Palliative Care, LLC
• Elite Medical Home Care LP
• Elliott Chiropractic Clinic, Inc.
• Lisa Elliott
• Steven Ray Elliott, D.C.
• Keven M Ellis, D.C.
• Lisa Gunter Ellis, PT

• Psychiatric/Mental Health Nurse Practitioner in Lufkin, TX
• Providers in Lufkin, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; 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.