Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP141844 | TX |
NPI | 1033761630 |
---|---|
Provider Name | Simon Kaitei |
First Address | Mckinney, TX 75070-0224 |
Second Address | Dallas, TX 75243-5150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 11/01/2022 |