MEDICARE: EDITH ABID TAKERE

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	67294	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	842869	NV
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G168214	IA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	273610	AZ
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1032215	TX
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024185259	VA

General Provider Information

NPI Number	:	1811661457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH ABID TAKERE

Provider Business Mailing Address
First Line	:	500 POPLAR VISTA LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4783
Country	:	US
Telephone Number	:	310-431-6627
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 POPLAR VISTA LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4783
Country	:	US
Telephone Number	:	310-431-6627
Fax Number	:

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

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	12/09/2025

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Directions to “ EDITH ABID TAKERE ” Practice Location

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