MEDICARE: MS. DAMALIE MUSOKE 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	202205123NP-PP	OR

General Provider Information

NPI Number	:	1487391199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAMALIE MUSOKE PMHNP-BC

Provider Business Mailing Address
First Line	:	2450 CONNELL RD BLDG 22643
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-7664
Country	:	US
Telephone Number	:	210-466-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 CONNELL RD BLDG 22643
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-7664
Country	:	US
Telephone Number	:	210-466-5606
Fax Number	:

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

Provider Enumeration Date	:	05/14/2022
Last Update Date	:	04/12/2023

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