NPI age
6 years
Enumerated 2019-11-14
● Active
Type 1 · Individual
Agnes Jeruto Mamboleo
Mamboleo is 1 of 11 licensed practical nurse providers in Fort Worth and 1 of 715 in Texas.
Primary specialty
Licensed Practical Nurse
Licensed in
MD
1 state
Status
Active
No deactivations on record
Last NPPES update
2019-11-14
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 715 active licensed practical nurse providers in Texas.
NPI age
6 years
≈ at median (7 yr)
State licenses
1 state
2% of peers hold multiple states
Subspecialties
0
7% of peers hold subspecialties
NPI lifetime · 2019 → 2026
2019-11Enumerated in NPPES
2019
2026
Where they practice
Practice location
4921 Woodmeadow Dr
Fort Worth, TX 761351824
Mailing address
4921 Woodmeadow Dr
Fort Worth, TX 761351824
Specialties
-
Licensed Practical Nurse PrimaryAn 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,...
Practice context
Solo or small practice. No other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.