Isimenmen Etakibuebu, DNP, M.ED., APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1157891 Issued in TX

Practice address

1631 E 2ND St Ste D
Austin, TX 78702-4491

Phone

(512) 804-3663

Fax

(512) 476-1469

NPI assigned

Apr 8, 2020

Last updated

Jan 19, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Austin Travis County Mental Health and Mental Retardation CenterGroup PAC ID 9133016306, 64 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education, 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Austin Travis County Mental Health and Mental Retardation Center

  dba Integral Care

  • Psychiatry Physician
  • Austin, TX
  • NPI 1750337259

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Austin Travis County Mental Health and Mental Retardation Center

  dba Integral Care

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Austin, TX
  • NPI 1053632505
  NPD
• Summit Mental Health Clinic PA

  • Clinic/Center
  • Austin, TX
  • NPI 1699945360
  NPD (past)

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737244800000",
    "number": "1679102883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 E 2ND ST STE D",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787024491",
            "telephone_number": "512-804-3663",
            "fax_number": "512-476-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 E 2ND ST STE D",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787024491",
            "telephone_number": "512-804-3663",
            "fax_number": "512-476-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETAKIBUEBU",
        "first_name": "ISIMENMEN",
        "credential": "DNP, M.ED., APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2025-01-19",
        "certification_date": "2025-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1157891",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "988738",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Austin, TX
• Providers in Austin, 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 Jan 19, 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.