CEREBRO LLC (NPI# 1336619329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336619329 |
| Entity Type | Organization |
| Organization Name | CEREBRO LLC |
| Practice Address |
307 E 1st St Ste 10-4 Prosper TX 75078-2973 |
| Mailing Address |
Po Box 1041 Prosper TX 75078-1041 |
| Practice Telephone | 9039461261 |
| Mailing Telephone | 9039461261 |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2018-12-13 |
| Authorized Official Name | PAMELA R EVANS (OWNER/PROVIDER) |
| Authorized Official Telephone | 9039461261 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | STATE ADVANCED PRACTICE LICENSE | AP139190 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Cerebro LLC | 2075 South University Blvd., Ste D126, Denver, CO 80210 |
| Street Address |
307 E 1ST ST STE 10-4 |
| City | PROSPER |
| State | TX |
| Zip Code | 75078-2973 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932734936 | Qnpham, Pllc | Optometrist | 4940 W. University Dr, Prosper, TX 75078 | 2020-03-10 |
| 1518592005 | Ferrari Orthodontics Pllc | Dentist | 1921 N Preston Rd, Proper, TX 75078 | 2020-03-05 |
| 1629538814 | 380 Smiles Pllc | Clinic/Center | 4940 W. University Dr., Suite 40, Prosper, TX 75078 | 2019-03-22 |
| 1558849158 | Samuel Oh Dmd Pllc | Dentist | 17569 Fishtrap Rd, Ste 80, Prosper, TX 75078 | 2018-08-06 |
| 1003303736 | National Vision, Inc. | Technician/Technologist | 871 South Preston Road, Prosper, TX 75078 | 2018-04-18 |
| 1265934749 | Lumincare Physician Group, Pa | Family Medicine | 1000 North Preston Road Suite 60, Prosper, TX 75078 | 2018-03-01 |
| 1164948436 | Dental Office of Prosper,pc | Dentist | 1180 N Preston Rd Suite 20, Prosper, TX 75078 | 2017-08-18 |
| 1750805602 | Texas Dental Surgery | Dentist | 1180 N Coit Rd Ste 40, Prosper, TX 75078 | 2017-08-02 |
| 1285168039 | Wal-mart Stores Texas LLC | Durable Medical Equipment & Medical Supplies | 500 Richland Boulevard, Prosper, TX 75078 | 2017-04-19 |
| 1679024897 | Cvs Pharmacy Inc. | Durable Medical Equipment & Medical Supplies | 2451 E. University Drive, Prosper, TX 75078 | 2016-10-24 |
| Find all providers in zip 75078 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215537857 | Julius Abam | Nurse Practitioner | 634 Rustic Trl, Midlothian, TX 76065-2267 | 2020-10-30 |
| 1750981619 | Suvekchya Subedi | Nurse Practitioner | 4032 Vista Mar Drive, Euless, TX 76040 | 2020-10-29 |
| 1821698754 | Christienne Felice Solis Callasan | Nurse Practitioner | 1010 Palos Verdes Blvd, Arlington, TX 76017-1780 | 2020-10-29 |
| 1932709201 | Aftercare, Pllc | Nurse Practitioner | 2000 Crawford St Ste 1221, Houston, TX 77002-9000 | 2020-10-27 |
| 1497355929 | Hector Medellin IIi | Nurse Practitioner | 6014 County Road 4068, Kemp, TX 75143-2600 | 2020-10-26 |
| 1639778947 | Aj Psychiatry Pllc | Nurse Practitioner | 1920 N Coit Rd Ste 219, Richardson, TX 75080-2832 | 2020-10-19 |
| 1154929735 | Valerie Michelle Vaughn-smith | Nurse Practitioner | 3105 Rockbrook Dr, Kilgore, TX 75662-2251 | 2020-10-15 |
| 1700483468 | Knd Behavioural Health Clinic | Nurse Practitioner | 103 Herrington Dr, Mansfield, TX 76063-7615 | 2020-10-06 |
| 1184231805 | Tihana Sladic | Nurse Practitioner | 1515 S Capital of Texas Hwy Ste 300&301, Austin, TX 78746-6579 | 2020-09-27 |
| 1679189369 | Charity Chioma Durant | Nurse Practitioner | 2310 Echo Ct, Rowlett, TX 75088-1534 | 2020-09-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CEREBRO LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.