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NPI Code Detail

MEDICARE: NASA PSYCHIATRIC CARE LLC

MEDICARE: NASA PSYCHIATRIC CARE LLC
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
1363LF0000XFamily Nurse Practitioner
2363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1508652140
Entity Type Code : Organization
Provider Name (Legal Business Name) : NASA PSYCHIATRIC CARE LLC
Provider Business Mailing Address
First Line : 6609 MCCART AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-5633
Country : US
Telephone Number : 817-386-7670
Fax Number : 682-428-7559
Provider Business Practice Location Address
First Line : 6609 MCCART AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-5633
Country : US
Telephone Number : 817-386-7670
Fax Number : 682-428-7559
Authorized Official
Title or Position : DIRECTOR
Name : AGNES AONDO
Credential :
Telephone Number : 817-386-7670
Provider Enumeration Date : 04/18/2025
Last Update Date : 06/05/2026

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Directions to “NASA PSYCHIATRIC CARE LLC ” Practice Location

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