Legacy Behavioral Health & Wellness
NPI 1528733359ActiveOrganization· Nurse Practitioner, Primary Care· Plano, TX
Nurse Practitioner, Primary Care in Plano, Texas, registered in NPPES in August 2021, part of Legacy Behavioral Health & Wellness. The authorized official on file is Mayra Cruz Koedam, FNP-C, PMHNP-BC, Nurse Practitioner.
Overview
| NPI | 1528733359 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Legacy Behavioral Health & Wellness |
| NPI issued | Aug 13, 2021 |
| Last updated in NPPES | Aug 13, 2021 |
| Certified by provider | Jul 19, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Primary Care Primary | 363LP2300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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