Organization
CEREBRO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA R EVANS NP (OWNER/PROVIDER)
(903) 946-1261
Entity
Organization
Contact information
Practice address
307 E 1ST ST STE 10-4, PROSPER, TX 75078-2973
(903) 946-1261
Mailing address
PO BOX 1041, PROSPER, TX 75078-1041
(903) 946-1261
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP139190
STATE ADVANCED PRACTICE LICENSE
TX
Enumeration date
12/03/2018
Last updated
12/13/2018
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