MEDICARE: SUMMIT RIDGE PSYCHIATRY 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	:	1851166961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT RIDGE PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	5555 EMERSON CT
Second Line	:
City	:	FAIRVIEW
State	:	TX
Zip	:	75069-6808
Country	:	US
Telephone Number	:	469-273-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	6205 LA VISTA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-4312
Country	:	US
Telephone Number	:	469-273-1540
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEAN COCHRAN
Credential	:	PMHNP-BC
Telephone Number	:	469-273-1540

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	09/02/2025

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