=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508489741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANDEM PSYCHIATRIC AND FAMILY PRACTICE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2020
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4781 S MAIN ST
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-404-5490
-----------------------------------------------------
Fax | 281-404-5494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1219 DEEP RIVER DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-6249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-404-5490
-----------------------------------------------------
Fax | 281-404-5494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIAL
-----------------------------------------------------
Name | NELLY OKERE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-528-5810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------