Chanelle Injeh Kunseh Fombo, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1019684 Issued in TX

Practice address

4215 Joe Ramsey Blvd E
Greenville, TX 75401-7852

Phone

(903) 408-5000

NPI assigned

Jun 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, VA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pulmonary Critical Care ProfessionalsGroup PAC ID 2062884471, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott & White Medical Center- Waxahachie Hospital, Waxahachie, TX, CCN 450372

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Pulmonary Critical Care Professionals

  • Pulmonary Disease Physician
  • Mansfield, TX
  • NPI 1922714179
  Medicare reassignment Care Compare group NPD
• Hunt Memorial Hospital District

  • General Acute Care Hospital
  • Greenville, TX
  • NPI 1598750721
  Medicare reassignment NPD
• Questcare Hospitalists PLLC

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1265441620

  Nurse Practitioner

  Medicare reassignment NPD
• Star MD of Arlington PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Dallas, TX
  • NPI 1124894308
  Medicare reassignment NPD
• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270
  Medicare reassignment NPD
• Hunt Memorial Hospital District

  • Skilled Nursing Facility
  • Royse City, TX
  • NPI 1750833901
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baylor Medical Center at Waxahachie

  • General Acute Care Hospital
  • Waxahachie, TX
  • NPI 1265430177
  Care Compare affiliation

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1851968614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 AIR PARK AVE",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754023000",
            "telephone_number": "903-408-5834",
            "fax_number": "903-408-5693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 JOE RAMSEY BLVD E",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754017852",
            "telephone_number": "903-408-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Cookeville",
            "state": "TN",
            "postal_code": "385014294",
            "country_code": "US",
            "telephone_number": "938-528-2541",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Sentara Cir Ste 201A",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "VA",
            "postal_code": "231885716",
            "country_code": "US",
            "telephone_number": "757-984-3975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOMBO",
        "first_name": "CHANELLE",
        "middle_name": "INJEH KUNSEH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024188872",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1019684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Scott Fields, MS, LPC
• Kamala D Fields, F NP-C
• Lauren Finney, APRN, FNP-C
• Lisa A Fite, MSN, PMHNP-BC
• Linda Lu Bailie Folden, LPC
• Azingala Ajua Fondong, MD
• Alexis Michelle Foote, LPC
• Harman Ford, LCDC
• Demarco Foreman
• Foresight Home Healthcare Incorporated

• Acute Care Nurse Practitioner in Greenville, TX
• Providers in Greenville, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.