Mary Lisa Duarte, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1055849 Issued in TX

Practice address

614 W Front St
Alice, TX 78332-7112

Phone

(361) 664-9587

Fax

(361) 668-0222

NPI assigned

Jul 11, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Lisa Trevino Former name

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Group practices

Coastal Plains Community MHMR CenterGroup PAC ID 1557337490, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Coastal Plains Community MHMR Center

  dba Coastal Plains Community Center

  • Psychiatry Physician
  • Portland, TX
  • NPI 1962552109
  Medicare reassignment Care Compare group NPD
• Coastal Plains Community MHMR Center

  dba Coastal Plains Community Center

  • Case Manager/Care Coordinator
  • Portland, TX
  • NPI 1861544124
  NPD
• Coastal Plains Community MHMR Center

  dba Coastal Plains Community Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, TX
  • NPI 1194104026
  NPD (past)
• Coastal Plains Community MHMR Center

  dba Coastal Plains Community Center

  • Case Management Agency
  • Portland, TX
  • NPI 1932251295
  NPD (past)

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1568140366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MARRIOTT DR",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783742213",
            "telephone_number": "361-777-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 W FRONT ST",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783327112",
            "telephone_number": "361-664-9587",
            "fax_number": "361-668-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUARTE",
        "first_name": "MARY",
        "middle_name": "LISA",
        "credential": "APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1055849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "TREVINO",
            "middle_name": "LISA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• James W Dorsett, LCDC
• Gerald Richard Dorsey, DDS
• Dr. Roel Garza and Associates Family Dentistry
• Nicholas Dunman, PHARMD
• Pamala J Edwards, PA
• Nabil El Milady, MD
• Eldercare Sollutions, LLC (Homecare Express)
• Elike Inc (Elsas Pillbox)

• Psychiatric/Mental Health Nurse Practitioner in Alice, TX
• Providers in Alice, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; 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.