MEDICARE: PSYCH MD TX LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LA2100X	Acute Care Nurse Practitioner
2	363LA2200X	Adult Health Nurse Practitioner
3	363LG0600X	Gerontology Nurse Practitioner
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	363LP2300X	Primary Care Nurse Practitioner
6	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1255283065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCH MD TX LLC

Provider Business Mailing Address
First Line	:	5519 W BANFF LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3045
Country	:	US
Telephone Number	:	623-261-5258
Fax Number	:	623-432-7006

Provider Business Practice Location Address
First Line	:	3537 S INTERSTATE 35 E STE 311
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-6870
Country	:	US
Telephone Number	:	623-301-9992
Fax Number	:	623-432-7006

Authorized Official
Title or Position	:	OWNER/PROVIDER/MEMBER/ADMIN
Name	:	DR. MALAR KUPPAN
Credential	:	DNP
Telephone Number	:	623-261-5258

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “PSYCH MD TX LLC ” Practice Location

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