NPIMap

Organization Active NPI

Southern Magnolia Management LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Spring, TX
National Provider Identifier
1346866845
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SOUTHERN MAGNOLIA MANAGEMENT LLC
Practice address
22325 Gosling Rd
Spring, TX 77389-4409
Phone
(281) 724-7980
NPI assigned
Jun 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Kevin Stump, NPNPI 1639331895
Title
Owner
Phone
(210) 787-8973

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

22325 Gosling Rd
Spring, TX 77389-4409

Mailing address

22325 Gosling Rd
Spring, TX 77389-4409
Phone (281) 724-7980

Other names 1

  • MAGNOLIA PSYCHIATRY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210811002623 TX Part B Supplier - Clinic/Group Practice 7810391984 Receives reassigned benefits from 34 practitioners
Practice locations: Boerne, TX; Conroe, TX; Cypress, TX; Humble, TX; Katy, TX; Spring, TX

National Provider Directory

National Provider Directory

Locations

501 E San Antonio Ave
Boerne, TX 78006
Phone (210) 951-9328

1904 Longmire Rd
Ste 401
Conroe, TX 77304

8118 Fry Rd
Ste 401
Cypress, TX 77433
Phone (281) 638-5349

8118 Fry Rd
Ste 1203
Cypress, TX 77433
Phone (716) 683-2717

13145 Spring Cypress Rd
Cypress, TX 77429

13803 Madera Run Pkwy
Ste 105
Humble, TX 77346

23410 Grand Reserve Dr
Ste 802
Katy, TX 77494

2743 Smith Ranch Rd
Ste 2304
Pearland, TX 77584
Phone (281) 937-4139

17015 Seven Pines Dr
Ste 4
Spring, TX 77379

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1346866845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22325 GOSLING RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773894409",
            "telephone_number": "281-724-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22325 GOSLING RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773894409",
            "telephone_number": "281-724-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAGNOLIA MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-787-8973",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAGNOLIA PSYCHIATRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spring, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.