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NPI Code Detail

MEDICARE: MARILYN OMOMEN AGPCNP, PMHNP

MEDICARE: MARILYN OMOMEN AGPCNP, 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
1363LG0600XGerontology Nurse PractitionerAP127499TX
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAP127499TX
3363LA2200XAdult Health Nurse Practitioner785075TX

General Provider Information

NPI Number : 1316337215
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN OMOMEN AGPCNP, PMHNP
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6101 W COURTYARD DR STE 2-225
Second Line :
City : AUSTIN
State : TX
Zip : 78730-5044
Country : US
Telephone Number : 512-956-5003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2015
Last Update Date : 08/21/2024

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