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General NPI Number Information
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NPI Number | 1982436705
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Entity Type | Individual
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Provider Name | TYSON JOHN OWEN PMHNP
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Gender | Male
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5038 TENNYSON PKWY STE B
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City | PLANO
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State | TX
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Zip | 75024-2965
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Country | US
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Telephone | 469-990-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 4606 CEDAR SPRINGS RD APT 1123
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City | DALLAS
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State | TX
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Zip | 75219-7206
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Country | US
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Telephone | 972-391-8855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1195478
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License Number State | TX
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