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MS. GRACIE MAE ADKISSON PMHNP-BC

Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1063799856

Individual Registrant:
MS. GRACIE MAE ADKISSON PMHNP-BC
Gender: F
Sole Proprietor

Location and contact information for practice:
2301 PECAN ST  TEXARKANA, AR 71854-3656 US
Tel: 903-278-5906  Fax: --

Contact information for business:
5812 MCKNIGHT RD  TEXARKANA, TX 75503-0960 US
Tel: 903-278-5906  Fax: --

Registration Information:
NPI: 1063799856
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Psychiatric/Mental Health
TXAP126190
N363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
AZAP4254
N363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
VA0024177015

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSE NUMBERAP126190TX01




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