Healthcare Provider Details

I. General information

NPI: 1386508455
Provider Name (Legal Business Name): ORDELIS MONTEJO MAGANA APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 SHADY HILL LN
ARLINGTON TX
76016-2124
US

IV. Provider business mailing address

5803 SHADY HILL LN
ARLINGTON TX
76016-2124
US

V. Phone/Fax

Practice location:
  • Phone: 682-213-0816
  • Fax:
Mailing address:
  • Phone: 682-213-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1045294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: