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General NPI Number Information
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NPI Number | 1336638253
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Entity Type | Individual
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Provider Name | FRIDAH OBONYO MONGARE PHNP
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Gender | Female
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 8111 LBJ FWY STE 900
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City | DALLAS
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State | TX
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Zip | 75251-1322
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Country | US
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Telephone | 469-262-6459
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S MAIN ST FL 10
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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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 | 1025041
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License Number State | TX
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