Active NPI
Amanda Tedford
- Family Nurse Practitioner
- Dallas, TX
National Provider Identifier
1790493609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 205704
- Practice address
- 4055 Valley View Lane
Dallas, TX 75244 - Phone
- (405) 245-6595
- NPI assigned
- Nov 9, 2022
- Last updated
- Nov 9, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 205704 | OK | Primary |
Addresses
Primary practice location
4055 Valley View Lane
Dallas, TX 75244
Mailing address
7916 NW 23Rd St # 127
Bethany, OK 73008-4950
Phone (405) 245-6595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 205704 | OK | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667952000000",
"number": "1790493609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7916 NW 23RD ST # 127",
"city": "BETHANY",
"state": "OK",
"postal_code": "730084950",
"telephone_number": "405-245-6595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4055 VALLEY VIEW LANE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75244",
"telephone_number": "405-245-6595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEDFORD",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-09",
"last_updated": "2022-11-09",
"certification_date": "2022-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OK",
"license": "205704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.