Healthcare Provider Details

I. General information

NPI: 1346871480
Provider Name (Legal Business Name): AGAPE ANESTHESIA CRNA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 N CENTRAL EXPY
DALLAS TX
75243-3755
US

IV. Provider business mailing address

1540 KELLER PKWY STE 108-429
KELLER TX
76248-4601
US

V. Phone/Fax

Practice location:
  • Phone: 972-972-4851
  • Fax:
Mailing address:
  • Phone: 972-533-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MALIA L STEPHENSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 972-533-0098