Provider Demographics
NPI:1659703023
Name:EFESOA, MARYANN M (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:M
Last Name:EFESOA
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SPINKS RD STE 133
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4451
Mailing Address - Country:US
Mailing Address - Phone:469-309-7834
Mailing Address - Fax:469-252-7098
Practice Address - Street 1:2201 SPINKS RD STE 133
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4451
Practice Address - Country:US
Practice Address - Phone:469-309-7834
Practice Address - Fax:469-252-7098
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123893363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325730503Medicaid
TX325730502Medicaid
TX325730501Medicaid
TX314385YKPWMedicare PIN
TX325730503Medicaid
TX314385YKP5Medicare PIN
TX325730502Medicaid