Lake Dallas Family Medicine PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

LAKE DALLAS FAMILY MEDICINE PLLC

Practice address

503 Main St Ste C
Lake Dallas, TX 75065-2878

Phone

(940) 535-5296

Fax

(940) 535-5297

NPI assigned

May 3, 2019

Last updated

Jun 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Carmen Phillips White, FNP-BC

Title

Owner

Phone

(214) 908-6012

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carmen Phillips White, FNP-BC

  • Family Nurse Practitioner
  • Lake Dallas, TX
  • NPI 1689831562
  Medicare reassignment Care Compare group NPD
• Madisen Tayler Stacks

  • Family Nurse Practitioner
  • Lake Dallas, TX
  • NPI 1063004158
  Medicare reassignment Care Compare group NPD
• Melissa Elizabeth Canter, PA

  • Physician Assistant
  • Carrollton, TX
  • NPI 1679898381
  Medicare reassignment

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

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1871158907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 MAIN ST STE C",
            "city": "LAKE DALLAS",
            "state": "TX",
            "postal_code": "750652878",
            "telephone_number": "940-535-5296",
            "fax_number": "940-535-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 MAIN ST STE C",
            "city": "LAKE DALLAS",
            "state": "TX",
            "postal_code": "750652878",
            "telephone_number": "940-535-5296",
            "fax_number": "940-535-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DALLAS FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-03",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "PHILLIPS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-908-6012",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• K2 Home Healthcare, Inc. (K2 Home Healthcare Service)
• Bonnie Kiefel, LCDC
• Jake Kim, DDS
• Kathy L. King, R.D.N.
• Jerome P. Kralka I
• Lake Dallas Isd
• Suzy Messinger, PTA
• Stephanie Mouser
• Sheillah Ncube
• Nalani M Newton, PTA

• Family Nurse Practitioner in Lake Dallas, TX
• Providers in Lake Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.