Healthcare Provider Details

I. General information

NPI: 1275874653
Provider Name (Legal Business Name): SOPHIA ESI BOATENG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN ST
RICHMOND TX
77469-3348
US

IV. Provider business mailing address

13319 PEACH ORCHARD LN
RICHMOND TX
77407-3232
US

V. Phone/Fax

Practice location:
  • Phone: 281-341-9696
  • Fax: 281-341-6218
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP122933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: