Active NPI
Jennifer Mayne-Farah, APRN, FNP-C
- Family Nurse Practitioner
- Mansfield, TX
National Provider Identifier
1992413124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1084100
- Practice address
- 1759 Broad Park Cir S
Mansfield, TX 76063-7833 - Phone
- (682) 341-3910
- Fax
- (682) 400-1288
- NPI assigned
- Nov 7, 2022
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1084100 | TX | Primary |
Addresses
Primary practice location
1759 Broad Park Cir S
Mansfield, TX 76063-7833
Mailing address
6204 Sea Meadow Dr
Fort Worth, TX 76132-1114
Phone (817) 475-9791
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1084100 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kidsville Pediatrics PLLC | Current | Accepting new patients |
Locations
1759 Broad Park Cir S
Mansfield, TX 76063
Phone (682) 341-3888
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.
-
- Pediatric Critical Care Medicine Physician
- Mansfield, TX
- NPI 1689264996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1992413124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6204 SEA MEADOW DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761321114",
"telephone_number": "817-475-9791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1759 BROAD PARK CIR S",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760637833",
"telephone_number": "682-341-3910",
"fax_number": "682-400-1288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYNE-FARAH",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "APRN, FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-07",
"last_updated": "2022-11-07",
"certification_date": "2022-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "1084100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.