Provider Demographics
NPI:1043254097
Name:NOVAK, AMY KATHARINE (RN, MSN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHARINE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-4302
Mailing Address - Country:US
Mailing Address - Phone:972-524-4159
Mailing Address - Fax:972-388-2009
Practice Address - Street 1:400 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4302
Practice Address - Country:US
Practice Address - Phone:972-524-4159
Practice Address - Fax:972-388-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health