MEDICARE: ABEBU Y TESFA NP

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	363L00000X	Nurse Practitioner	1014751	TX

General Provider Information

NPI Number	:	1477142875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABEBU Y TESFA NP

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-606-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 PRESIDENT GEORGE BUSH TPKE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-6629
Country	:	US
Telephone Number	:	800-218-8989
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	12/28/2023

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