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NPI Code Detail

MEDICARE: MR. AMIR ALI HOMAYOUNKHAH PMHNP-BC

MEDICARE: MR. AMIR ALI HOMAYOUNKHAH 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1137324TX

General Provider Information

NPI Number : 1518739754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. AMIR ALI HOMAYOUNKHAH PMHNP-BC
Provider Business Mailing Address
First Line : 1113 S SYLVAN AVE
Second Line :
City : PALESTINE
State : TX
Zip : 75801-5132
Country : US
Telephone Number : 903-373-2139
Fax Number :
Provider Business Practice Location Address
First Line : 379 FM 2972 W
Second Line :
City : RUSK
State : TX
Zip : 75785-3666
Country : US
Telephone Number : 903-683-5781
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2023
Last Update Date : 10/23/2023

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