=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124719380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAVINIEN SIEWE PMHNP - BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2023
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 S W S YOUNG DR
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76543-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-226-3090
-----------------------------------------------------
Fax | 888-595-2540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21873 WOODCOCK WAY
-----------------------------------------------------
City | CLARKSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20871-9527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-404-1751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 1194536
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------