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NPI Code Detail

MEDICARE: DUSTIN RICHARD HUSEMANN ACNP-BC, PMHNP-BC

MEDICARE: DUSTIN RICHARD HUSEMANN ACNP-BC, 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
1363LA2100XAcute Care Nurse PractitionerAP11403AZ
2363LP0808XPsychiatric/Mental Health Nurse Practitioner209022157IL
3363LP0808XPsychiatric/Mental Health Nurse PractitionerAP11403AZ

General Provider Information

NPI Number : 1548756794
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN RICHARD HUSEMANN ACNP-BC, PMHNP-BC
Provider Business Mailing Address
First Line : 3159 10TH AVE N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33713-6627
Country : US
Telephone Number : 503-866-3772
Fax Number :
Provider Business Practice Location Address
First Line : 914 N SAN FRANCISCO ST STE D
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-3254
Country : US
Telephone Number : 928-985-1495
Fax Number : 928-597-5198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2018
Last Update Date : 06/11/2025

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