Healthcare Provider Details

I. General information

NPI: 1982489126
Provider Name (Legal Business Name): STELLA A BEDIAKO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STELLA A BEDIAKO PMHNP

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHERN AVE STE 202A
PHOENIX AZ
85021-5471
US

IV. Provider business mailing address

5641 COVENTRY DR
PROSPER TX
75078-1250
US

V. Phone/Fax

Practice location:
  • Phone: 972-547-8000
  • Fax:
Mailing address:
  • Phone: 469-471-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number295323
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1126698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: