Individual provider Active NPI

Quinnet A Momoh, FNP

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1811473960
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP135981 Issued in TX
Practice address
5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone
(469) 419-9162
NPI assigned
Jul 12, 2018
Last updated
Jul 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP135981 TX Primary

Addresses

Primary practice location

5200 Harry Hines Blvd
Dallas, TX 75235-7709

Mailing address

3012 Fairview Dr
Grand Prairie, TX 75052-0443
Phone (817) 472-9046

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210129000168 TX Practitioner - Nurse Practitioner 0446428643

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Holistic Wound & Diabetic Care LLC Family CurrentSince Oct 5, 2021 Accepting new patients
Devine Holistic Home Health Care Inc CurrentSince Jun 13, 2011 Accepting new patients

Locations

1420 Valwood Pkwy
Ste 170
Carrollton, TX 75006
Phone (469) 834-0722

2580 W Camp Wisdom Rd
Ste 100126
Grand Prairie, TX 75052

Interoperability endpoints

  • Direct secure messaging: quinnet.momoh@hwadcl-tx.direct.office.nextgen.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1811473960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 FAIRVIEW DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750520443",
            "telephone_number": "817-472-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357709",
            "telephone_number": "469-419-9162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOMOH",
        "first_name": "QUINNET",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-12",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP135981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.