CLARA FORMUSOH NP NPI 1023406576

NPI Information

NPI: 1023406576
Provider Name: CLARA FORMUSOH, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1300 W TERRELL AVE STE K230
FORT WORTH, TX
ZIP 76104
Phone: (817) 250-4906
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Clara Formusoh, NP is a family nurse practitioner in Fort Worth, TX with 10 years of experience. Clara Formusoh, NP NPI is 1023406576. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1300 W TERRELL AVE STE K230
FORT WORTH, TX
ZIP 76104-820
Phone: (817) 250-4906
Fax: (817) 250-1815

The NPI 1023406576 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/7/2015 and was last updated on 2/17/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	AP127181	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	392281YKPW	MEDICARE PIN	TEXAS
2	343075301	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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