SOUMANA DJIBO
NPI 1760148753
Nurse Practitioner - Family in Southlake, TX
About Soumana Djibo NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUMANA DJIBO (NPI 1760148753) is an individual family provider in Southlake, Texas, licensed in Texas (AP141893) and active in the NPI registry since November 2021. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Soumana Djibo is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 76092 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SOUTHLAKE, TX 76092
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Soumana Djibo's NPI number?
The NPI number for Soumana Djibo is 1760148753. It was assigned to this individual provider in the NPPES registry on November 13, 2021.
Where is Soumana Djibo located?
Soumana Djibo practices at 855 Davis Blvd, Southlake, TX 76092. The listed phone number is (817) 912-1771.
What is Soumana Djibo's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Soumana Djibo enrolled in Medicare?
Yes. Soumana Djibo is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Soumana Djibo was last updated on October 31, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Soumana Djibo · NPI 1760148753
Family physician in Southlake, Texas. Individual provider, active in the CMS NPPES registry since November 13, 2021.
## Identity
- **NPI:** 1760148753 (Entity type: Individual)
- **Enumerated:** November 13, 2021
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** AP141893 (Texas)
- **Sole proprietor:** No
## Practice location
- **Address:** 855 DAVIS BLVD, Southlake, TX 76092-8244
- **Phone:** (817) 912-1771
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for durable medical equipment, power mobility devices
## Record status
- **NPPES last updated:** October 31, 2022
- **Other identifiers:** Medicaid 1760148753 (TX)
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Source: [NPI Profile](https://npiprofile.com/npi/1760148753) · Data from the CMS NPPES public registry.