Petrisor Tudor, PMHNP-BC, APRN, MSN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

114357 Issued in NE

Practice address

11404 W Dodge Rd Ste 300
Omaha, NE 68154-2511

Phone

(402) 898-1113

Fax

(402) 819-5588

NPI assigned

Sep 14, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Restore Rebuild Reconnect Counseling CenterGroup PAC ID 3678910809, 4 clinicians

Pro Care Mental Health IncGroup PAC ID 3274815279, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pro Care Mental Health Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Waterloo, NE
  • NPI 1356885024
  Medicare reassignment Care Compare group NPD
• Restore Rebuild Reconnect Counseling Center

  • Adult Mental Health Clinic/Center
  • Omaha, NE
  • NPI 1679128318
  Medicare reassignment Care Compare group NPD
• Affect Provider Group, P.S.C.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Danville, KY
  • NPI 1326799081

  Psychiatric/Mental Health

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1194447367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 S 243RD ST",
            "city": "WATERLOO",
            "state": "NE",
            "postal_code": "680694704",
            "telephone_number": "402-417-2524",
            "fax_number": "402-465-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11404 W DODGE RD STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542511",
            "telephone_number": "402-898-1113",
            "fax_number": "402-819-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUDOR",
        "first_name": "PETRISOR",
        "credential": "PMHNP-BC, APRN, MSN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-14",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NE",
            "license": "114357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026632500",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Queen Esther Rose Tucker
• Shontae Tucker
• Shynez K Tucker
• Steven Forrest Tucker Jr.
• Tylena Tucker
• Jackie Marie Tuff
• Bania Tule Mejia
• Britney Tull
• Austin Monroe Tullis
• Julianne O'Keefe Tullis, CMSW, LMHP

• Psychiatric/Mental Health Nurse Practitioner in Omaha, NE
• Providers in Omaha, NE by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.