Provider Demographics
NPI:1104423573
Name:PAYUMO, SALVADOR A JR (PMHNP)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:A
Last Name:PAYUMO
Suffix:JR
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5199
Mailing Address - Country:US
Mailing Address - Phone:830-896-2211
Mailing Address - Fax:
Practice Address - Street 1:721 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5199
Practice Address - Country:US
Practice Address - Phone:830-896-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875228163W00000X
TX1015717363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse