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General NPI Number Information
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NPI Number | 1003579913
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Entity Type | Organization
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Legal Business Name | LIVE OAK PSYCHIATRIC AND FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 1100 NW LOOP 410
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2263
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Country | US
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Telephone | 347-607-9126
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Fax |
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Provider Business Mailing Address
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Address Line | 11230 FOREST PASS CT
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City | LIVE OAK
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State | TX
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Zip | 78233-7236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | NAKEITRA CURTIS
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Credential |
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Telephone | 254-466-1749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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