Active NPI
Mary Medina, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- McKinney, TX
National Provider Identifier
1710641089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 1057358
- Practice address
- 4300 Community Ave
McKinney, TX 75071-2535 - Phone
- (972) 547-5232
- NPI assigned
- Oct 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1057358 | TX | Primary |
Addresses
Primary practice location
4300 Community Ave
McKinney, TX 75071-2535
Mailing address
13353 Citrus LN
Frisco, TX 75035-0024
Phone (972) 400-5060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1057358 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634947200000",
"number": "1710641089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13353 CITRUS LN",
"city": "FRISCO",
"state": "TX",
"postal_code": "750350024",
"telephone_number": "972-400-5060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 COMMUNITY AVE",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750712535",
"telephone_number": "972-547-5232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "PMHNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-23",
"last_updated": "2021-10-23",
"certification_date": "2021-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "TX",
"license": "1057358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKinney, TX
- Medical Interpretation & Therapy
- Medical Weight Management Internal Medicine (Physicians of Medicine)
- Brenda Lisbeth Medina-Flores, M.S.,
- Cynthia Renae Medina-McMann, DDS
- Antonio C Medina, MFT
- Medinatherapy PLLC (The Good Center)
- Medrocs Corporation LLC
- Medrocs Corporation LLC (Medrocs Pharmacy)
- Medspring of Texas, PA
- Medstream Healthcare Associates
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.