Healthcare Provider Details

I. General information

NPI: 1922898782
Provider Name (Legal Business Name): MARGUERITE MARIE ESSAMA-MEKONGO ONDOA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BLOOMING CT
FORT WORTH TX
76244-5805
US

IV. Provider business mailing address

4401 BLOOMING CT
FORT WORTH TX
76244-5805
US

V. Phone/Fax

Practice location:
  • Phone: 405-431-7821
  • Fax:
Mailing address:
  • Phone: 405-431-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number1196837
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1196837
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1196837
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: