Individual provider Active NPI

Adelwisa C Ave

  • Family Nurse Practitioner
  • Plano, TX
National Provider Identifier
1891336020
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1042845 Issued in TX
Practice address
850 Central Pkwy E Ste 275
Plano, TX 75074-5542
Phone
(972) 881-4688
NPI assigned
Sep 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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 1042845 TX Primary

Addresses

Primary practice location

850 Central Pkwy E Ste 275
Plano, TX 75074-5542

Mailing address

2251 Middle Creek Dr
Kingwood, TX 77339-1719
Phone (972) 881-4688

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
I20240212004142 TX Practitioner - Nurse Practitioner 8729418223 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Physiatry Group LLC CurrentSince Jan 26, 2024 Accepting new patients
Paragon Clinical Midwest, LLC Nurse Practitioner Past Accepting new patients
Osf Multi-Specialty Group PastSince Nov 17, 2020 Accepting new patients

Locations

850 Central Pkwy E
Ste 275
Plano, TX 75074

1419 Mahlmann St
Rosenberg, TX 77471
Phone (281) 342-0065

Organizations & group practices 3

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": "1569715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1891336020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 MIDDLE CREEK DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773391719",
            "telephone_number": "972-881-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 CENTRAL PKWY E STE 275",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750745542",
            "telephone_number": "972-881-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVE",
        "first_name": "ADELWISA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-29",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1042845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.