Provider Demographics
NPI:1194796094
Name:SEYMOUR, CONNIE M (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:M
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 W CALLE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5663
Mailing Address - Country:US
Mailing Address - Phone:480-907-4798
Mailing Address - Fax:
Practice Address - Street 1:1500 N WILMOT RD STE A200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4416
Practice Address - Country:US
Practice Address - Phone:520-873-8562
Practice Address - Fax:888-851-7021
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1750163WP0809X, 363LP0808X
WAAP60779720363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ60018Medicare UPIN