Provider Demographics
NPI:1326518085
Name:SEPULVEDA, ROEL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROEL
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 YORK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2066
Mailing Address - Country:US
Mailing Address - Phone:972-283-6286
Mailing Address - Fax:214-217-4819
Practice Address - Street 1:941 YORK DR STE 205
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2066
Practice Address - Country:US
Practice Address - Phone:972-283-6286
Practice Address - Fax:214-217-4819
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139255363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health