Neo2Teen Pediatric Clinic, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

P2438 Issued in TX

Legal business name

NEO2TEEN PEDIATRIC CLINIC, PA

Practice address

6735 FM 78
Suite 103
San Antonio, TX 78244-1367

Phone

(210) 888-9960

Fax

(210) 888-9422

NPI assigned

Feb 26, 2017

Organization subpart

No

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

Authorized official

Name

Kenneth Etokhana, MDNPI 1629233127

Title

President

Phone

(210) 888-9960

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15846/brand/1/csg/1/fhir/r4

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Oshiokhayamhe Etokhana, M.D

  • Pediatrics Physician
  • San Antonio, TX
  • NPI 1629233127
  NPD (past) Authorized official
• Eden Louise Frandsen, APRN

  • Pediatric Nurse Practitioner
  • San Antonio, TX
  • NPI 1710470968
  NPD (past)
• Shelby Danielle Gonzalez, CPNP-PC

  • Pediatric Nurse Practitioner
  • San Antonio, TX
  • NPI 1861375511
  NPD (past)
• Laura Pilar Hymel, APRN CPNP PC

  • Pediatric Nurse Practitioner
  • San Antonio, TX
  • NPI 1558006932
  NPD (past)
• Connie Elizabeth Vick, APRN, FNP-C

  • Allergy & Immunology Physician
  • San Antonio, TX
  • NPI 1487363941
  NPD (past)

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

{
    "created_epoch": "1488067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1770023624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23723 SUNSET PEAK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782587544",
            "telephone_number": "210-888-9960",
            "fax_number": "210-888-9422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 FM 78",
            "address_2": "SUITE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782441367",
            "telephone_number": "210-888-9960",
            "fax_number": "210-888-9422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEO2TEEN PEDIATRIC CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-26",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "ETOKHANA",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-888-9960",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "P2438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• T. Russell Nelson, PH.D.
• Tylan Mekkai Nelson
• William Joseph Nelson, D.C.
• Haile Nemariam
• Vishal Nemarugommula, MBBS
• Sivaram Neppala, MD
• Elizabeth Nepsund
• Neptune Anesthesia Services, PLLC
• Wendolyn Leigh Neptune
• Kristen Ashley Nerdahl, CPNP

• Pediatrics Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.