Healthcare Provider Details

I. General information

NPI: 1184459422
Provider Name (Legal Business Name): BRENDA YAWA AMEGA NTSAKPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11914 ASTORIA BLVD STE 520
HOUSTON TX
77089-6074
US

IV. Provider business mailing address

930 FROSTWOOD DR STE 2.200
HOUSTON TX
77024-2450
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-0202
  • Fax: 281-332-5266
Mailing address:
  • Phone: 713-338-5502
  • Fax: 713-338-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: