Healthcare Provider Details

I. General information

NPI: 1306247598
Provider Name (Legal Business Name): MERCELINE OBUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 N CENTRAL EXPY STE 340
DALLAS TX
75243-3755
US

IV. Provider business mailing address

12222 N CENTRAL EXPY
DALLAS TX
75243-3755
US

V. Phone/Fax

Practice location:
  • Phone: 972-972-4851
  • Fax: 972-556-5202
Mailing address:
  • Phone: 972-972-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: