Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1750926630 Individual Practitioner Female Practitioner

Agnes Jeruto Mamboleo

Licensed Practical Nurse • Fort Worth, TX

Professional Overview & Biography Verified Profile Summary

Agnes Mamboleo is a registered healthcare professional specializing in Licensed Practical Nurse in Fort Worth, TX. Practice services are available at 4921 WOODMEADOW DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4921 Woodmeadow Dr

Fort Worth, TX 761351824

Telephone 3012046081

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Fort Worth, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 12.0 Yrs
Regional Practice Density
12 Specialists

Practicing in Fort Worth, TX (727 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License MD LP35237

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active November 14, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location November 14, 2019

Registered at 4921 WOODMEADOW DR, FORT WORTH, TX 761351824 (Tel: 3012046081)

📍
Updated Business Mailing Address November 14, 2019

Registered at 4921 WOODMEADOW DR, FORT WORTH, TX 761351824 (Tel: 3012046081)

👤
Provider Name / Credentials Updated November 14, 2019

Recorded as AGNES MAMBOLEO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 14, 2019

Licensed Practical Nurse (License #LP35237 in MD)

🟢
Initial NPI Registration & Enumeration November 14, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1750926630
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 14, 2019
Last Update: November 14, 2019
Sole Proprietor: No

Mailing Address

4921 Woodmeadow Dr

Fort Worth, TX 761351824

Phone: 3012046081

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.