Individual provider Active NPI

Ma Camille Tabtab, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Rusk, TX
National Provider Identifier
1265008395
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1041920 Issued in TX
Practice address
108 S Main St Unit 555
Rusk, TX 75785-1335
Phone
(903) 392-9886
NPI assigned
May 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1041920 TX Primary

Addresses

Primary practice location

108 S Main St Unit 555
Rusk, TX 75785-1335

Mailing address

PO Box 774
Henderson, TX 75653-0774
Phone (903) 392-9886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20231016002817 TX Practitioner - Nurse Practitioner 1951756659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
79.54 of 100Reported as group
Quality
72.94
Improvement activities
40
Cost
48.08

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1041920TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Med Management Associates CurrentSince Nov 20, 2023 Accepting new patients

Locations

4006 Vista Rd
Pasadena, TX 77504
Phone (713) 943-1592

7272 Wurzbach Rd
Ste 601
San Antonio, TX 78240
Phone (210) 615-3472

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1622332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1265008395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 774",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "756530774",
            "telephone_number": "903-392-9886",
            "fax_number": "903-765-7573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 S MAIN ST UNIT 555",
            "city": "RUSK",
            "state": "TX",
            "postal_code": "757851335",
            "telephone_number": "903-392-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABTAB",
        "first_name": "MA CAMILLE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-30",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1041920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rusk, TX

Sources for this page

Verify at the official NPI Registry.