MEDICARE: RESHMI DUTTA PMHNP

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	363LF0000X	Family Nurse Practitioner	AP127576	TX
2	2084P0800X	Psychiatry Physician	AP127576	TX

General Provider Information

NPI Number	:	1144607565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHMI DUTTA PMHNP

Provider Business Mailing Address
First Line	:	400 STONEBROOK PKWY UNIT 205
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-1181
Country	:	US
Telephone Number	:	945-267-0422
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 STONEBROOK PKWY UNIT 205
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-1181
Country	:	US
Telephone Number	:	972-977-8388
Fax Number	:

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	07/21/2024

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