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NPI Code Detail

MEDICARE: VANAJAKSHI DATTATREYA PMHNP

MEDICARE: VANAJAKSHI DATTATREYA 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 PractitionerAP70000791WA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner1089225TX

General Provider Information

NPI Number : 1912626045
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANAJAKSHI DATTATREYA PMHNP
Provider Business Mailing Address
First Line : 509 PORT ISABEL LN
Second Line :
City : MCKINNEY
State : TX
Zip : 75071-6718
Country : US
Telephone Number : 248-631-7805
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 : 469-714-0006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 04/23/2026

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