FOREVER KIDS PEDIATRIC CLINIC (NPI# 1326435199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326435199 |
| Entity Type | Organization |
| Organization Name | FOREVER KIDS PEDIATRIC CLINIC |
| Practice Address |
182 Privatet Road 6413 Canton TX 75103 |
| Mailing Address |
205 W Tyler St Canton TX 75103-1352 |
| Practice Telephone | 2147735669 |
| Mailing Telephone | 9035675437 |
| Mailing Fax Number | 8446786258 |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2020-02-11 |
| Authorized Official Name | MRS. LACY DAWN BURKES (PEDIATRIC NURSE PRACTITIONER) |
| Authorized Official Telephone | 2147735669 |
| Authorized Official Credential | RN , CPNP-PC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 261Q00000X | Clinic/Center | 754047 | TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | NPI | 1750646279 | 01 |
| TX | 1349815603 | 05 |
| Street Address |
182 PRIVATET ROAD 6413 |
| City | CANTON |
| State | TX |
| Zip Code | 75103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265095202 | Brandi Jo Foster | Nurse Practitioner | 4437 Etheride Circle, Canton, TX 75103 | 2019-04-16 |
| 1124595087 | Melissa Williams | Nurse Practitioner | 1108 So. Buffalo St, Canton, TX 75103 | 2018-10-30 |
| 1295218667 | Jennifer Elaine Moore | Registered Nurse | 185 Vz Cr 2103, Canton, TX 75103 | 2018-09-12 |
| 1568945921 | Kelsey Lauren Nixon | Registered Nurse | 5640 Vzcr 4106, Canton, TX 75103 | 2018-09-12 |
| 1649770496 | Chelsea Boshart | Registered Nurse | 150 Vz Cr 4130, Canton, TX 75103 | 2018-02-19 |
| 1396292918 | Deanne Wheeler | Hearing Instrument Specialist | 150 E. Dallas Street, Canton, TX 75103 | 2016-09-01 |
| 1356701221 | Betsy Jill Chappell | Nurse Practitioner | 406 Tx-243, Canton, TX 75103 | 2016-03-04 |
| 1417255233 | Dallas County Hospital District | Skilled Nursing Facility | 1901 S Trade Days Blvd, Canton, TX 75103 | 2011-03-02 |
| 1922243906 | Brookshire Grocery Company | Pharmacy | 880 E State Highway 243, Canton, TX 75103 | 2008-12-05 |
| 1285833533 | Sondra J Mahoney | Counselor | 1343 Vz Cr 4414, Canton, TX 75103 | 2007-07-17 |
| Find all providers in zip 75103 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457710139 | Aria Lg Counseling and Wellness Center, LLC | Clinic/Center | 5262 Fulton Road Nw, Canton, OH 44718 | 2016-02-23 |
| 1760810287 | Davis Family Health Care | Clinic/Center | 162 Feather Ln Ste E, Canton, MS 39046-8510 | 2013-10-18 |
| 1831430909 | Advanced Ob-gyn of Dearborn, P.C. | Clinic/Center | 2263 Pinecroft Dr, Unit 216, Canton, MI 48188-2247 | 2013-03-13 |
| 1801075338 | Canton Professional Services, Inc. | Clinic/Center | 5900 N. Lilley Rd, Suite 104, Canton, MI 48187-3971 | 2007-11-01 |
| 1902096381 | Delta Group of Michigan Inc | Clinic/Center | 41148 Williamsburg Blvd, Canton, MI 48187-3963 | 2007-07-31 |
| 1619042017 | Rdm Center, Inc. | Clinic/Center | 5820 N Lilley Rd, Suite 7, Canton, MI 48187-3686 | 2006-11-21 |
| 1366402422 | Ican Inc. | Clinic/Center | 1214 Market Ave N, Canton, OH 44714-2604 | 2006-03-24 |
| 1639146095 | Domestic Violence Project, Inc | Clinic/Center | 720 19th St Ne, Canton, OH 44714-2213 | 2006-03-03 |
| 1467432765 | United Cerebral Palsy Association of The North Country, Inc. | Clinic/Center | 4 Commerce Ln, Canton, NY 13617-3739 | 2006-01-20 |
| 1336706506 | North East Ohio Endoscopy Center Inc | Clinic/Center | 4124 Munson St Nw, Canton, OH 44718-4804 | 2019-05-23 |
| Find all providers in CANTON | ||||
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| 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.