Active NPI
Abi Mikkel Provence, MSN, FNP-BC & FNP-C
- Primary Care Nurse Practitioner
- Arlington, TX
National Provider Identifier
1922587872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- AP138443
- Practice address
- 6108 Shorewood Dr
Arlington, TX 76016-2649 - Phone
- (817) 435-2812
- NPI assigned
- Aug 11, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | AP138443 | TX | Primary |
Addresses
Primary practice location
6108 Shorewood Dr
Arlington, TX 76016-2649
Mailing address
PO Box 170428
Arlington, TX 76003-0428
Phone (817) 729-7853
Other practice location 1
1811 Highway 287 N
Mansfield, TX 76063-7571
Other practice location 2
4740 W University Dr Ste 190
Prosper, TX 75078-9092
Phone (469) 716-4950
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP138443 | TX | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mission Haven Rediemed | Current | Accepting new patients |
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.
-
- Family Medicine Physician
- Arlington, TX
- NPI 1558062059
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1922587872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 170428",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760030428",
"telephone_number": "817-729-7853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6108 SHOREWOOD DR",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760162649",
"telephone_number": "817-435-2812"
}
],
"practiceLocations": [
{
"address_1": "1811 Highway 287 N",
"address_purpose": "LOCATION",
"city": "Mansfield",
"state": "TX",
"postal_code": "760637571",
"country_code": "US",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4740 W University Dr Ste 190",
"address_purpose": "LOCATION",
"city": "Prosper",
"state": "TX",
"postal_code": "750789092",
"country_code": "US",
"telephone_number": "469-716-4950",
"fax_number": "469-716-4950",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PROVENCE",
"first_name": "ABI",
"middle_name": "MIKKEL",
"credential": "MSN, FNP-BC & FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-11",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "TX",
"license": "AP138443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.