MEDICARE: JOANNA AHOUNOU PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	692426	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326475153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNA AHOUNOU PA

Provider Business Mailing Address
First Line	:	PO BOX 54455
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-4455
Country	:	US
Telephone Number	:	817-896-3547
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 6TH AVE
Second Line	:	SUITE B
City	:	FT WORTH
State	:	TX
Zip	:	76110-3800
Country	:	US
Telephone Number	:	682-312-7339
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	JOANNA AHOUNOU
Credential	:	PMHNP
Telephone Number	:	817-896-3547

Provider Enumeration Date	:	10/12/2013
Last Update Date	:	12/11/2015

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Directions to “JOANNA AHOUNOU PA ” Practice Location

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