MEDICARE: BLOOMING MINDS 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	:	1346104163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING MINDS PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	9550 SKILLMAN ST STE 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-8261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9550 SKILLMAN ST STE 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-8261
Country	:	US
Telephone Number	:	209-486-2590
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	ONYINYE OBIORAH
Credential	:
Telephone Number	:	209-486-2590

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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