Individual
FARIDY MAYA MOMBELEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 S FM 51 STE C, DECATUR, TX 76234-3702
(940) 626-1848
(940) 626-1849
Mailing address
1816 S FM 51 STE 400, DECATUR, TX 76234-3788
(940) 626-1848
(940) 626-1849
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP140998
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BCBSTX
TX
05
—
PENDING
—
TX
Enumeration date
03/20/2019
Last updated
10/19/2022
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