Provider Demographics
NPI:1114131661
Name:GOTCHER, MARY (APRN-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GOTCHER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 MESA DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3434
Mailing Address - Country:US
Mailing Address - Phone:940-387-5788
Mailing Address - Fax:940-591-7830
Practice Address - Street 1:4310 MESA DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3434
Practice Address - Country:US
Practice Address - Phone:940-387-5788
Practice Address - Fax:940-591-7830
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health