Healthcare Provider Details

I. General information

NPI: 1457158479
Provider Name (Legal Business Name): ABIGAIL UDEME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W BEDFORD EULESS RD
HURST TX
76053-4006
US

IV. Provider business mailing address

117 W BEDFORD EULESS RD
HURST TX
76053-4006
US

V. Phone/Fax

Practice location:
  • Phone: 817-268-0041
  • Fax: 817-977-9037
Mailing address:
  • Phone: 817-268-0041
  • Fax: 817-977-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1191763
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: