MEDICARE: MS. JOSEPHINE DEDE TEYE-KOFI

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	163W00000X	Registered Nurse	885431	TX
2	363L00000X	Nurse Practitioner	1228755	TX

General Provider Information

NPI Number	:	1467943670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOSEPHINE DEDE TEYE-KOFI

Provider Business Mailing Address
First Line	:	2715 LAKE TERRACE DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-6590
Country	:	US
Telephone Number	:	214-600-3289
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 LAKE TERRACE DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-6590
Country	:	US
Telephone Number	:	214-600-3289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	03/11/2026

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