MEDICARE: MS. CONNIE M SEYMOUR 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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	AP1750	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60779720	WA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP1750	AZ

General Provider Information

NPI Number	:	1194796094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE M SEYMOUR PMHNP-BC

Provider Business Mailing Address
First Line	:	1762 W CALLE LA PAZ
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-5663
Country	:	US
Telephone Number	:	480-907-4798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N WILMOT RD STE A200
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4416
Country	:	US
Telephone Number	:	520-873-8562
Fax Number	:	888-851-7021

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/19/2023

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