Organization Active NPI

LTH Family Medicine

  • Family Nurse Practitioner
  • Desoto, TX
National Provider Identifier
1801486543
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
LTH FAMILY MEDICINE
Practice address
705 Camelia CT
Desoto, TX 75115-1521
Phone
(214) 280-0266
Fax
(214) 291-9311
NPI assigned
Jan 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Mrs. Kashaelyn L Hollins-Henderson, FAMILY NURSE PRACTITNPI 1912493230
Title
Owner
Phone
(214) 280-0266

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
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

705 Camelia CT
Desoto, TX 75115-1521

Mailing address

705 Camelia CT
Desoto, TX 75115-1521
Phone (214) 280-0266

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210301000856 TX Part B Supplier - Clinic/Group Practice 9830505726 Receives reassigned benefits from 2 practitioners
Practice locations: Waxahachie, TX

National Provider Directory

National Provider Directory

Locations

1795 N Highway 77
Ste 104
Waxahachie, TX 75165
Phone (214) 764-3943

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1801486543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 CAMELIA CT",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751151521",
            "telephone_number": "214-280-0266",
            "fax_number": "214-291-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 CAMELIA CT",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751151521",
            "telephone_number": "214-280-0266",
            "fax_number": "214-291-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTH FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "HOLLINS-HENDERSON",
        "authorized_official_first_name": "KASHAELYN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-280-0266",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FAMILY NURSE PRACTIT"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.