CONNIE E DEDMON PNP NPI 1467437954

NPI Information

  • NPI: 1467437954
  • Provider Name: CONNIE E DEDMON, PNP
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4405 RIVER OAKS BLVD
    FORT WORTH, TX
    ZIP 76114
  • Phone: (817) 624-1770

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NPI Details

Connie E Dedmon, PNP is a pediatrics nurse practitioner in Fort Worth, TX. Connie E Dedmon, PNP NPI is 1467437954. 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:

4405 RIVER OAKS BLVD
FORT WORTH, TX
ZIP 76114-326
Phone: (817) 624-1770
Fax: (817) 625-1287

The NPI 1467437954 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 12/7/2005 and was last updated on 4/3/2012.

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
1363LP0200XNurse PractitionerPediatrics230593TEXASYes

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
1184937403MEDICAIDTEXAS
2184937401MEDICAIDTEXAS
38J3335MEDICARE PIN
41750369203OTHERGROUP NPI

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: 11/21/2025

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