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General NPI Number Information
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NPI Number | 1720580053
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Entity Type | Organization
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Legal Business Name | MOONRISE MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 3516 NE STALLINGS DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-8732
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Country | US
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Telephone | 936-564-9785
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Fax | 936-564-4136
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Provider Business Mailing Address
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Address Line | 734 COUNTY ROAD 411
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City | GARY
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State | TX
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Zip | 75643-5435
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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 | OWNER
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Name | DR. SHERRY VAN METER
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Credential | DNP, RN, PMHNP, WHNP
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Telephone | 903-918-2123
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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 | AP111655
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License Number State | TX
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