Provider Demographics
NPI:1639914716
Name:TEXADA, CHARLI (PMHNP)
Entity type:Individual
Prefix:
First Name:CHARLI
Middle Name:
Last Name:TEXADA
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TRIUMPH BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6475
Mailing Address - Country:US
Mailing Address - Phone:801-821-2781
Mailing Address - Fax:
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4412
Practice Address - Country:US
Practice Address - Phone:801-821-2781
Practice Address - Fax:801-901-1194
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169248363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health