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General NPI Number Information
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NPI Number | 1124725627
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Entity Type | Individual
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Provider Name | FATIMA FOFANA APRN
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Gender | Female
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 1302 TORRINGTON LN
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City | FORNEY
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State | TX
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Zip | 75126-1250
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Country | US
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Telephone | 214-315-4652
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 W PARK ROW DR STE C
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City | PANTEGO
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State | TX
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Zip | 76013-2047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1071616
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License Number State | TX
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