Individual provider Active NPI

Dorace Lisa Bedard, N.P.

  • Psychiatric/Mental Health Nurse Practitioner
  • Dickinson, TX
National Provider Identifier
1992102149
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP114077 Issued in TX
Practice address
5509 Attwater Ave
Dickinson, TX 77539-4157
Phone
(409) 948-0001
NPI assigned
Dec 2, 2014
Last updated
Dec 2, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP114077 TX Primary

Addresses

Primary practice location

5509 Attwater Ave
Dickinson, TX 77539-4157

Mailing address

3227 Moss St
La Marque, TX 77568-4612
Phone (409) 935-3423

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)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP114077TXMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417478400000",
    "number": "1992102149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3227 MOSS ST",
            "city": "LA MARQUE",
            "state": "TX",
            "postal_code": "775684612",
            "telephone_number": "409-935-3423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5509 ATTWATER AVE",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775394157",
            "telephone_number": "409-948-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDARD",
        "first_name": "DORACE",
        "middle_name": "LISA",
        "name_prefix": "Ms.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-02",
        "last_updated": "2014-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP114077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dickinson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; 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.