1013706936 NPI number — OMEGA MENTAL WELLNESS

Table of content: MIKALA LEE ROMINE FNP (NPI 1184115016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013706936 NPI number — OMEGA MENTAL WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMEGA MENTAL WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013706936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 BALCONES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-4257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-318-2199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W WALKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76501-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-677-8874
Provider Business Practice Location Address Fax Number:
254-677-8874
Provider Enumeration Date:
05/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
LOSOYA
Authorized Official First Name:
SHANNA
Authorized Official Middle Name:
SAMON
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
254-677-8874

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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