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WACO BLUEBONNET HOLDINGS, INC.
NPI 1760282289
Nurse Practitioner in Waco, TX

Active since March 14, 2025
307 LONDONDERRY DR, WACO, TX 76712(254) 751-1790(254) 751-7295 Get Directions Write a Review

NPPES record last updated: March 14, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Waco Bluebonnet Holdings, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WACO BLUEBONNET HOLDINGS, INC. (NPI 1760282289), doing business as Bluebonnet Health Services Supportive Care, is a healthcare organization registered as a nurse practitioner in Waco, Texas and active in the NPI registry since March 2025. The organization lists Brent Mckenzie, Cfo, as its authorized official.

NPPES Registry Identity

NPI1760282289
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameWACO BLUEBONNET HOLDINGS, INC.
Location Address307 LONDONDERRY DRWaco, TX 76712-7915
Mailing Address307 Londonderry DrWaco, TX 76712-7915 · (254) 751-1790 · Fax (254) 751-7295
Phone(254) 751-1790
Fax(254) 751-7295
Organization SubpartNo
Authorized OfficialBrent MckenzieCfo · (254) 772-5577
Enumeration DateMarch 14, 2025
NPPES CertifiedMarch 14, 2025
✔ NPI 1760282289 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
307 LONDONDERRY DR, Waco, TX 76712
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Other Names 1

Doing Business AsBluebonnet Health Services Supportive Care

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Waco Bluebonnet Holdings, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Waco Bluebonnet Holdings, Inc., which bills Medicare for the services this clinician delivers.

Clinician (1)

Janis Giles, FNP
Nurse Practitioner
NPI 1871585737
100 HILLCREST MEDICAL BLVD
Waco, TX 76712
(254) 202-2000
✔ PECOS✔ Accepts Medicare2.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D1091160

Waco Bluebonnet Holdings, Inc D/B/A Bluebonnet Health Services · Waco, TX
Expired · Oct 26, 2026
CLIA Number45D1091160
Laboratory TypeHospice
Certificate Effective DateOctober 27, 2024
Certificate Expiration DateOctober 26, 2026
Laboratory DirectorMark Walsh
Laboratory Phone(254) 751-1790
Laboratory LocationWaco Bluebonnet Holdings, Inc D/B/A Bluebonnet Health Services307 Londonderry, Waco, TX 76712
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Waco Bluebonnet Holdings, Inc.'s NPI number?

The NPI number for Waco Bluebonnet Holdings, Inc. is 1760282289. It was assigned to this organization in the NPPES registry on March 14, 2025. The provider is doing business as Bluebonnet Health Services Supportive Care.

Where is Waco Bluebonnet Holdings, Inc. located?

Waco Bluebonnet Holdings, Inc. is located at 307 Londonderry Dr, Waco, TX 76712. The listed phone number is (254) 751-1790.

What is Waco Bluebonnet Holdings, Inc.'s specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Waco Bluebonnet Holdings, Inc. enrolled in Medicare?

Yes. Waco Bluebonnet Holdings, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Waco Bluebonnet Holdings, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Waco Bluebonnet Holdings, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Waco Bluebonnet Holdings, Inc. was last updated on March 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.