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General NPI Number Information
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NPI Number | 1861378168
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Entity Type | Organization
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Legal Business Name | TEXAS SPECIALTY PHYSICIANS
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4000 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-8467
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Country | US
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Telephone | 903-731-5442
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Fax | 903-723-3325
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Provider Business Mailing Address
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Address Line | 4002 S LOOP 256 STE A
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City | PALESTINE
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State | TX
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Zip | 75801-8492
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Country | US
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Telephone | 903-731-5442
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Fax | 903-723-3325
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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