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MS. GRACIE MAE ADKISSON PMHNP-BC
Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1063799856
Individual Registrant:MS. GRACIE MAE ADKISSON PMHNP-BC
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
2301 PECAN ST TEXARKANA, AR 71854-3656 US
Tel: 903-278-5906 Fax: --
Tel: 903-278-5906 Fax: --
Contact information for business:
5812 MCKNIGHT RD TEXARKANA, TX 75503-0960 US
Tel: 903-278-5906 Fax: --
Tel: 903-278-5906 Fax: --
Registration Information:
NPI: 1063799856
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Psychiatric/Mental Health | TX | AP126190 |
| N | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | AZ | AP4254 |
| N | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | VA | 0024177015 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| STATE LICENSE NUMBER | AP126190 | TX | 01 |
