Provider Demographics
NPI:1598376204
Name:MCNABB, MISTY HEATHER (PMHNP BC APRN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:HEATHER
Last Name:MCNABB
Suffix:
Gender:M
Credentials:PMHNP BC APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9164 CRANSTON CT
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5802
Mailing Address - Country:US
Mailing Address - Phone:214-554-5321
Mailing Address - Fax:
Practice Address - Street 1:8501 WADE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6262
Practice Address - Country:US
Practice Address - Phone:972-668-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007364363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35509OtherPRESCRIPTIVE AUTHORITY NUMBER FOR TEXAS BOARD OF NURSING