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General NPI Number Information
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NPI Number | 1316736424
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Entity Type | Organization
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Legal Business Name | PREMIER PANORAMA PSYCHIATRY PLLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1601 E LAMAR BLVD STE 214
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City | ARLINGTON
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State | TX
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Zip | 76011-4464
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Country | US
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Telephone | 682-336-1943
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Fax | 682-316-9194
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Provider Business Mailing Address
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Address Line | 1601 E LAMAR BLVD STE 214
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City | ARLINGTON
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State | TX
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Zip | 76011-4464
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Country | US
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Telephone | 682-336-1943
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Fax | 682-316-9194
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | DIANA I RICKETTS
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Credential |
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Telephone | 682-336-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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