Healthcare Provider Details

I. General information

NPI: 1336940824
Provider Name (Legal Business Name): LISA ANN DEJESUS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S STAPLES ST STE 406
CORPUS CHRISTI TX
78413-2952
US

IV. Provider business mailing address

6000 S STAPLES ST STE 406
CORPUS CHRISTI TX
78413-2952
US

V. Phone/Fax

Practice location:
  • Phone: 361-444-5255
  • Fax: 361-998-9698
Mailing address:
  • Phone: 361-444-5255
  • Fax: 631-998-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number931734
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: