# CEREBRO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336619329
- **Authorized official:** PAMELA R EVANS NP (OWNER/PROVIDER)
- **Authorized official phone:** (903) 946-1261

## Contact information

- **Practice address:** 307 E 1ST ST STE 10-4, PROSPER, TX 75078-2973
- **Practice address phone:** (903) 946-1261
- **Mailing address:** PO BOX 1041, PROSPER, TX 75078-1041
- **Mailing address phone:** (903) 946-1261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2018
- **Last updated:** 12/13/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | AP139190 | STATE ADVANCED PRACTICE LICENSE | TX |