Provider Demographics
NPI:1962191775
Name:MCCOLLISTER, AUNDREA RICHAE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AUNDREA
Middle Name:RICHAE
Last Name:MCCOLLISTER
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 1:7010 HARBOR VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3788
Mailing Address - Country:US
Mailing Address - Phone:214-864-5349
Mailing Address - Fax:
Practice Address - Street 1:633 E. FERNHURST DR #304
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77578
Practice Address - Country:US
Practice Address - Phone:877-631-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20030361821363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health