Healthcare Provider Details

I. General information

NPI: 1487044897
Provider Name (Legal Business Name): ADAOBI MOEMENAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2015
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 FALL CREEK HWY
GRANBURY TX
76049-7913
US

IV. Provider business mailing address

14821 BRETTRIDGE DR
ALEDO TX
76008-1437
US

V. Phone/Fax

Practice location:
  • Phone: 817-326-3440
  • Fax:
Mailing address:
  • Phone: 310-800-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95000421
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number293115
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP131032
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number293115
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: