MEDICARE: MRS. DIMITRA DENISE MCGHEE AGPCNP-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	363LA2200X	Adult Health Nurse Practitioner	AP137174	TX
2	363LP2300X	Primary Care Nurse Practitioner	AP137174	TX
3	363LG0600X	Gerontology Nurse Practitioner	AP137174	TX

General Provider Information

NPI Number	:	1730685108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIMITRA DENISE MCGHEE AGPCNP-C

Provider Business Mailing Address
First Line	:	1826 N LOOP 1604 W STE 32
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-4527
Country	:	US
Telephone Number	:	210-875-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1826 N LOOP 1604 W STE 32
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-4527
Country	:	US
Telephone Number	:	210-875-0413
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	10/02/2025

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