MEDICARE: KASSIE R SONGER 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1171890	TX

General Provider Information

NPI Number	:	1528891157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSIE R SONGER PMHNP

Provider Business Mailing Address
First Line	:	3014 COUNTY ROAD SW 3010
Second Line	:
City	:	MT VERNON
State	:	TX
Zip	:	75457-6548
Country	:	US
Telephone Number	:	903-285-4108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3014 COUNTY ROAD SW 3010
Second Line	:
City	:	MT VERNON
State	:	TX
Zip	:	75457-6548
Country	:	US
Telephone Number	:	903-285-4108
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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