MEDICARE: SOUTHWEST AGAPE WELLNESS, PLLC

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

General Provider Information

NPI Number	:	1699581082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST AGAPE WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	4103 WILBARGER ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3137
Country	:	US
Telephone Number	:	940-655-8291
Fax Number	:	940-304-8197

Provider Business Practice Location Address
First Line	:	4103 WILBARGER ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3137
Country	:	US
Telephone Number	:	940-655-8291
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER / OWNER
Name	:	GUSTAVO ALCANTAR ALEMAN JR.
Credential	:	PMHNP-BC
Telephone Number	:	940-655-8291

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	11/13/2025

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