Healthcare Provider Details

I. General information

NPI: 1205405644
Provider Name (Legal Business Name): ESHA KACKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N HALSTED ST FL 234
CHICAGO IL
60642-2517
US

IV. Provider business mailing address

7401 BLUE BEACH CV
AUSTIN TX
78759-6424
US

V. Phone/Fax

Practice location:
  • Phone: 516-407-8558
  • Fax:
Mailing address:
  • Phone: 512-632-7427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.023336
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1035252
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.023336
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.509746
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number916707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: