MEDICARE: MICHAEL T. ANDREPONT-AYCOCK CRNA, PMHNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1200576	TX
2	367500000X	Certified Registered Nurse Anesthetist	680898	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033117882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T. ANDREPONT-AYCOCK CRNA, PMHNP-C

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:	214-590-4105
Fax Number	:	214-590-4162

Provider Business Practice Location Address
First Line	:	5201 HARRY HINES BLVD
Second Line	:	DEPT. OF ANESTHESIOLOGY
City	:	DALLAS
State	:	TX
Zip	:	75235-7708
Country	:	US
Telephone Number	:	214-590-8329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	03/02/2026

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