Healthcare Provider Details

I. General information

NPI: 1386582021
Provider Name (Legal Business Name): SHAUNTRESSE ERIN BOSARGE PMHNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MILLER ST STE 2
KYLE TX
78640-4046
US

IV. Provider business mailing address

240 TURTLE CREEK DR
KYLE TX
78640-4199
US

V. Phone/Fax

Practice location:
  • Phone: 512-256-0067
  • Fax:
Mailing address:
  • Phone: 504-782-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1219132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: