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General NPI Number Information
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NPI Number | 1255283065
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Entity Type | Organization
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Legal Business Name | PSYCH MD TX LLC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 3537 S INTERSTATE 35 E STE 311
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City | DENTON
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State | TX
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Zip | 76210-6870
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Country | US
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Telephone | 623-301-9992
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Fax | 623-432-7006
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Provider Business Mailing Address
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Address Line | 5519 W BANFF LN
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City | GLENDALE
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State | AZ
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Zip | 85306-3045
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Country | US
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Telephone | 623-261-5258
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Fax | 623-432-7006
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Authorized Official
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Title or Position | OWNER/PROVIDER/MEMBER/ADMIN
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Name | DR. MALAR KUPPAN
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Credential | DNP
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Telephone | 623-261-5258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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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 | 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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Taxonomy #5
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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 #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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