Monika Lucille Revlett, LPN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

LPN0000063953 Issued in TN

Practice address

1610 6TH Ave
Fort Worth, TX 76104-4331

Phone

(931) 624-0126

NPI assigned

Oct 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Monika Lucille Dominiak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1891261483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 6TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044331",
            "telephone_number": "931-624-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 6TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044331",
            "telephone_number": "931-624-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVLETT",
        "first_name": "MONIKA",
        "middle_name": "LUCILLE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TN",
            "license": "LPN0000063953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONIKA",
            "last_name": "DOMINIAK",
            "middle_name": "LUCILLE",
            "prefix": "MS.",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Licensed Vocational Nurse in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Licensed Vocational Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.