CONNIE E DEDMON (NPI# 1467437954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467437954 |
| Entity Type | Individual |
| Full Name | CONNIE E DEDMON |
| Credential | PNP |
| Practice Address |
4405 River Oaks Blvd Fort Worth TX 76114-2326 |
| Mailing Address |
Po Box 99371 Fort Worth TX 76199-0371 |
| Practice Telephone | 8176241770 |
| Practice Fax Number | 8176251287 |
| Mailing Telephone | 6828851855 |
| Mailing Fax Number | 6828857347 |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2012-04-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
230593 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 184937403 | 05 | |
| TX | 184937401 | 05 | |
| GROUP NPI | 1750369203 | 01 |
| Street Address |
4405 RIVER OAKS BLVD |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76114-2326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457903767 | Leslie Powers | Speech-Language Pathologist | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2019-07-16 |
| 1285151456 | Monica Sterling | Speech-Language Pathologist | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2017-08-28 |
| 1790186740 | Jessica Lucero | Nurse Practitioner | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2014-09-09 |
| 1972947620 | Margarita Sandoval | Physician Assistant | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2013-04-24 |
| 1558622365 | Wendy Beth White | Physician Assistant | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2012-06-07 |
| 1659389757 | Hector Grajeda Acosta | Pediatrics | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2006-08-04 |
| 1962455162 | Heather L. Miller | Pediatrics | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2006-05-18 |
| 1649258633 | Clara Sue Forrester | Nurse Practitioner | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2006-01-09 |
| 1982698114 | Laila N Jiwani | Pediatrics | 4405 River Oaks Blvd, Fort Worth, TX 76114-2326 | 2005-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952917957 | Jennie Bauchert | Massage Therapist | 1205 Roaring Springs Rd., Ft Worth, TX 76114 | 2020-09-16 |
| 1417438243 | North Texas Area Community Health Centers, Inc | Pharmacy | 2332 Beverly Hills Drive Ste 1116, Ft. Worth, TX 76114 | 2018-08-29 |
| 1023525573 | Jennifer Christine Arriaga | Occupational Therapy Assistant | 125 Smallwood, Fort Worth, TX 76114 | 2018-01-05 |
| 1831617216 | Kailene Allis | Specialist/Technologist | 5519 Norte Dame Ave, River Oaks, TX 76114 | 2017-09-06 |
| 1336662022 | Ben Luka | Dentist | 639 Alta Mere Dr, Fort Worth, TX 76114 | 2017-07-25 |
| 1750771382 | Signature Family Dentistry Pllc | Dentist | 4839 River Oaks Blvd., River Oaks, TX 76114 | 2015-02-04 |
| 1447668223 | Wal-mart Stores Texas, LLC | Technician/Technologist | 2245 Jacksonboro Hwy, Ft. Worth, TX 76114 | 2014-07-24 |
| 1558611897 | Walgreens | Pharmacist | 5716 Aton Ave, Westworth Village, TX 76114 | 2012-09-13 |
| 1437439551 | Ashley Kristen Murrey | Dentist | 6628 Westworth Blvd, Westworth Village, TX 76114 | 2011-08-20 |
| 1598054637 | Ashley Anne Trabon | Physician Assistant | 4819 River Oaks, Fort Worth, TX 76114 | 2011-03-29 |
| Find all providers in zip 76114 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770182636 | Jenna Donlon | Nurse Practitioner | 3201 Western Center Blvd Ste 125, Fort Worth, TX 76137-7135 | 2020-10-21 |
| 1023594009 | Erica M Lucas | Nurse Practitioner | 800 8th Ave Ste 200, Fort Worth, TX 76104-2619 | 2018-07-13 |
| 1003280686 | Susan Akberzie | Nurse Practitioner | 3400 Texas Sage Trl Ste 148, Fort Worth, TX 76177 | 2015-11-19 |
| 1427489400 | Brenda Bosch | Nurse Practitioner | 11807 Med Park Dr, Ste 365, Fort Worth, TX 76028-3509 | 2013-12-02 |
| 1447535463 | Anamarina Jarecke | Nurse Practitioner | 5300 Buchanan St, Fort Worth, TX 76114-1304 | 2011-10-21 |
| 1770873077 | Michelle Beatrice Oconnor | Nurse Practitioner | 6239 Granbury Rd, Fort Worth, TX 76133-3401 | 2011-04-08 |
| 1912208687 | Andrea Madeliene Newman | Nurse Practitioner | 901 7th Ave Ste 120, Fort Worth, TX 76104-2724 | 2010-11-10 |
| 1629306709 | Autumn Brianne Morris | Nurse Practitioner | 901 W Rosedale St, Fort Worth, TX 76104-4672 | 2009-11-30 |
| 1235466624 | Courtney Shea Stewart | Nurse Practitioner | 5917 Yosemite Dr, Fort Worth, TX 76112-3938 | 2009-11-06 |
| 1548412018 | Christie Ramirez | Nurse Practitioner | 8376 Mojave Trl, Fort Worth, TX 76116-3638 | 2008-10-16 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76114 |
Please comment or provide details below to improve the information on CONNIE E DEDMON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.