MEDICARE: ALI SARGEANT PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1029041	TX

General Provider Information

NPI Number	:	1053282160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI SARGEANT PMHNP-BC

Provider Business Mailing Address
First Line	:	12407 N MOPAC EXPY STE 250-263
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN STE 202
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2190
Country	:	US
Telephone Number	:	512-434-8975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2025
Last Update Date	:	09/13/2025

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