Provider Demographics
NPI:1982436705
Name:OWEN, TYSON JOHN (PMHNP)
Entity type:Individual
Prefix:MR
First Name:TYSON
Middle Name:JOHN
Last Name:OWEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 CEDAR SPRINGS RD APT 1123
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7206
Mailing Address - Country:US
Mailing Address - Phone:972-391-8855
Mailing Address - Fax:
Practice Address - Street 1:5038 TENNYSON PKWY STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2965
Practice Address - Country:US
Practice Address - Phone:469-990-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195478363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty