MEDICARE: MRS. JOANNA N AHOUNOU PMHNP

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	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	:	1750634002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA N AHOUNOU PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 54455
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76054-4455
Country	:	US
Telephone Number	:	817-679-0133
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	12/12/2016

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