Habtom Legese Teweldebrahan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP141274 Issued in TX

Practice address

2727 LBJ Fwy Ste 326
Dallas, TX 75234-7478

Phone

(214) 935-5791

Fax

(214) 935-5717

NPI assigned

Jun 10, 2021

Last updated

Jun 10, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Collin House Call Physician LLC

  • Family Nurse Practitioner
  • Dallas, TX
  • NPI 1437871761
  Medicare reassignment NPD Authorized official
• Sierra Wound Care LLC

  • Multi-Specialty Clinic/Center
  • Dallas, TX
  • NPI 1699391003
  NPD

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1881261584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 LBJ FWY STE 326",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752347478",
            "telephone_number": "214-935-5791",
            "fax_number": "214-935-5717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 LBJ FWY STE 326",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752347478",
            "telephone_number": "214-935-5791",
            "fax_number": "214-935-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEWELDEBRAHAN",
        "first_name": "HABTOM",
        "middle_name": "LEGESE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP141274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica M Tetrault, LPC
• Veronica Tetterton, PH.D
• Kendra Tevis, LCSW
• Sarah Abigail Tevis, DDS
• Hena Tewari, M.D.
• Texacare Hospice Incorporated
• Texas a&M University College of Dentistry
• Texas a&M University System Health Science Center (Texas A&M School of Dentistry)
• Texas a&M University System Health Science Center (Texas A&M School of Dentistry)
• Texas Acute Pain Service, PLLC

• Family Nurse Practitioner in Dallas, TX
• Providers in 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 10, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.