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NPI Code Detail

MEDICARE: AKTSA SIMON PMHNP

MEDICARE: AKTSA SIMON PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1016286TX

General Provider Information

NPI Number : 1316545072
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKTSA SIMON PMHNP
Provider Business Mailing Address
First Line : 5825 WILLOW LN
Second Line :
City : THE COLONY
State : TX
Zip : 75056-6454
Country : US
Telephone Number : 214-604-4019
Fax Number :
Provider Business Practice Location Address
First Line : 4801 MEDICAL CENTER DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75069-1881
Country : US
Telephone Number : 972-369-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2020
Last Update Date : 10/15/2020

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