MEDICARE: MY BETHEL PSYCHIATRY PLLC

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

General Provider Information

NPI Number	:	1245185230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY BETHEL PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	6010 W SPRING CREEK PKWY # 709
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3569
Country	:	US
Telephone Number	:	945-253-5657
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 W SPRING CREEK PKWY # 709
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3569
Country	:	US
Telephone Number	:	945-253-5657
Fax Number	:

Authorized Official
Title or Position	:	NP/CLINICIAN
Name	:	UKA ROSE ILODIANYA
Credential	:	PMHNP
Telephone Number	:	945-253-5657

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	05/26/2026

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