Individual provider Active NPI

Ndeloke Lauduine Tajong, NP

  • Family Nurse Practitioner
  • Conroe, TX
National Provider Identifier
1861162406
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1054564 Issued in TX
Practice address
690 S Loop 336 W Ste 215
Conroe, TX 77304-3322
Phone
(936) 828-3962
Fax
(936) 828-3967
NPI assigned
Sep 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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 1054564 TX Primary

Addresses

Primary practice location

690 S Loop 336 W Ste 215
Conroe, TX 77304-3322

Mailing address

14 N Fazio Way
Spring, TX 77389-2701
Phone (443) 799-0028

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
I20241217001740 TX Practitioner - Nurse Practitioner 4587191424 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Gastroenterology and Liver Specialists, PLLC CurrentSince Nov 4, 2024 Accepting new patients

Locations

690 S Loop 336 W
Ste 215
Conroe, TX 77304
Phone (936) 228-9980

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AAEABA

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1861162406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 N FAZIO WAY",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773892701",
            "telephone_number": "443-799-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 W STE 215",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043322",
            "telephone_number": "936-828-3962",
            "fax_number": "936-828-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAJONG",
        "first_name": "NDELOKE",
        "middle_name": "LAUDUINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1054564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.