Individual provider Active NPI

Mariana Allison, NP

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1982301222
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1109842 Issued in TX
Practice address
700 Olympic Plaza Cir Ste 850
Tyler, TX 75701-1955
Phone
(903) 596-3504
NPI assigned
Feb 7, 2023
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1109842 TX Primary

Addresses

Primary practice location

700 Olympic Plaza Cir Ste 850
Tyler, TX 75701-1955

Mailing address

700 Olympic Plaza Cir Ste 850
Tyler, TX 75701-1955
Phone (903) 596-3504

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
I20230315002984 TX Practitioner - Nurse Practitioner 4183098080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians
Henderson Hospital LLCGroup PAC ID 4789946054, shared by 3 NPIs, 11 clinicians
East Texas Medical Center HendersonGroup PAC ID 9234288861, 11 clinicians
Henderson Memorial HospitalGroup PAC ID 9739159682, 11 clinicians

Practice addresses (Care Compare)

100 Municipal Dr
Suite 300
Gun Barrel City, TX 75156-3703
Phone (903) 713-1574

18118 FM 344
Flint, TX 75762-6010
Phone (903) 825-3292

300 Wilson St
Henderson, TX 75652-5956
Phone (903) 655-6536

700 Olympic Plaza Cir
Suite 850
Tyler, TX 75701-1955
Phone (903) 596-3504

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1109842TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2023 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2023 Accepting new patients
Charles R Gordon MD PA CurrentSince Nov 18, 2024 Accepting new patients
Charles R Gordon MD PA Nurse Practitioner CurrentSince Nov 18, 2024 Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

700 Olympic Plaza Cir
Ste 600
Tyler, TX 75701
Phone (903) 594-2666

700 Olympic Plaza Cir
Ste 850
Tyler, TX 75701
Phone (903) 595-2441

Interoperability endpoints

  • Direct secure messaging: mariana.ponce.d1.p1@direct.precisionspinecare.nextgenshare.com
  • Direct secure messaging: mponce357454@ahs.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1982301222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 850",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011955",
            "telephone_number": "903-596-3504",
            "fax_number": "903-596-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 850",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011955",
            "telephone_number": "903-596-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLISON",
        "first_name": "MARIANA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-07",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1109842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.