Provider Demographics
NPI:1548756794
Name:HUSEMANN, DUSTIN RICHARD (ACNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RICHARD
Last Name:HUSEMANN
Suffix:
Gender:M
Credentials:ACNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6627
Mailing Address - Country:US
Mailing Address - Phone:503-866-3772
Mailing Address - Fax:
Practice Address - Street 1:914 N SAN FRANCISCO ST STE D
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3254
Practice Address - Country:US
Practice Address - Phone:928-985-1495
Practice Address - Fax:928-597-5198
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11403363LA2100X, 363LP0808X
IL209022157363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care