Custommadeimagehealth and Wellness

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

Legal business name

CUSTOMMADEIMAGEHEALTH AND WELLNESS

Practice address

825 Watters Creek Blvd Ste 250
Allen, TX 75013-3770

Phone

(214) 945-3702

NPI assigned

Aug 14, 2023

Last updated

Aug 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tonya WilliamsNPI 1013383421

Title

Nurse Practitioner

Phone

(214) 945-3702

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tonya Williams, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Plano, TX
  • NPI 1013383421
  NPD Authorized official

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1417730631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1972 SUNNY SIDE DR",
            "city": "LITTLE ELM",
            "state": "TX",
            "postal_code": "750687803",
            "telephone_number": "214-797-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 WATTERS CREEK BLVD STE 250",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750133770",
            "telephone_number": "214-945-3702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOMMADEIMAGEHEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "214-945-3702"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Psychiatric/Mental Health Registered Nurse in Allen, TX
• Providers in Allen, TX by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.