Healthcare Provider Details

I. General information

NPI: 1518821289
Provider Name (Legal Business Name): AVID MIND PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 ORIOLE BLVD
DUNCANVILLE TX
75116-3500
US

IV. Provider business mailing address

3236 KOSCHER DR
CEDAR HILL TX
75104-1050
US

V. Phone/Fax

Practice location:
  • Phone: 972-333-9798
  • Fax:
Mailing address:
  • Phone: 972-333-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NOSIMOT ADEPEGBA
Title or Position: CEO
Credential:
Phone: 972-333-9798