Provider Demographics
NPI:1114621554
Name:ROSE PSYCHIATRIC ASSOCIATE PLLC
Entity Type:Organization
Organization Name:ROSE PSYCHIATRIC ASSOCIATE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN-CNP, PMHNP
Authorized Official - Phone:469-545-0902
Mailing Address - Street 1:409 S CENTRAL EXPY STE 107-514
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-4909
Mailing Address - Country:US
Mailing Address - Phone:469-545-0902
Mailing Address - Fax:469-960-3925
Practice Address - Street 1:409 S CENTRAL EXPY STE 107-514
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-4909
Practice Address - Country:US
Practice Address - Phone:469-545-0902
Practice Address - Fax:469-960-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty