MEDICARE: SOUL SPRING 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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1902616907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL SPRING PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	2100 GEORGE DIETER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3815
Country	:	US
Telephone Number	:	704-340-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 GEORGE DIETER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3815
Country	:	US
Telephone Number	:	704-340-4431
Fax Number	:	979-316-1851

Authorized Official
Title or Position	:	NP
Name	:	PRINCESS AHEDOR
Credential	:	PMHNP
Telephone Number	:	704-340-4431

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	02/09/2026

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