MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1922244904

MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC) is a healthcare provider. based in Tyler, Texas. specializing in NURSE PRACTITIONER. They hold the professional credentials RN, PMHNP-BC, LPC. They hold a License No. 62107 (TX). The NPI Number for MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC) is 1922244904

Main info

Female
9 Years Of Experience
Accepts Medicare Assignment
Name
MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC)
NPI
1922244904
Phone
(512) 573-8026
Address
1405 S Fleishel Ave
Enumeration Date
23 December 2008
Last Update Date
21 July 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5124724357
Graduation Year
2017 (9 years ago)
PAC ID
5092072470
Group Practice PAC ID
9133016306
Professional Enrollment ID
I20171121001182
Address ID
TX787442701AU5015XIHXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness75
Years active:17State licenses:2Digital endpointsOther names

22,204 NURSE PRACTITIONER in TX

Provider Addresses for MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC)

  • 1405 S Fleishel Ave

    Suite #332

    Tyler, TX 757013345

    Phone: (512) 573-8026

    Type: Location

  • 3320 S Loop 256

    Palestine, TX 758016984

    Phone: (903) 723-6136

    Type: Location

  • 1011, College Avenue, Jacksonville, Cherokee County, Texas, 75766, United States

    JACKSONVILLE, TX 757663307

    Phone: (512) 573-8026

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $398.

Total Amount is formed as General ($398) + Research ($0) + Ownership ($0) = $398.

Last reported payment date: 2024-11-02 • Largest payer in this snapshot: ABBVIE INC. ($228).

Total Amount

$398

General + Research + Ownership

Payments

4

Total payment records

General Amount

$398

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-02

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-11-21

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20171121001182INurse PractitionerTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 75701)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9133016306View full group profile
NameSpecialtyState
Physician AssistantTX
-TX
-TX
-TX
Nurse PractitionerTX
Clinical Social WorkerTX
P S Y C H I A T R YTX
Mental Health CounselorTX
Nurse PractitionerTX
Clinical Social WorkerTX

Reviews

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Frequently asked questions

What NPI should I save for MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC)?
Save NPI 1922244904 if you need a stable reference for MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC).
Does this profile mean MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC) is currently active?
Yes — MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC) appears active in the national provider directory.
What kind of provider is MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC)?
The page reflects Psychiatric/Mental Health Nurse Practitioner for MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC). Clinical services aligned with this taxonomy classification.
Where is MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC)'s primary listing?
We display Tyler, Texas because that is what the record indicates for MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC).
Is MS. ROXANNE D. DUDLEY (RN, PMHNP-BC, LPC) a real provider?
This page reflects official NPPES data for NPI 1922244904. Always confirm identity and privileges with the practice and licensing boards.

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