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General NPI Number Information
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NPI Number | 1760927172
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Entity Type | Individual
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Provider Name | DEEPA TONY ABRAHAM
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Gender | Female
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 609 HEMPHILL ST
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City | FORT WORTH
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State | TX
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Zip | 76104-3149
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Country | US
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Telephone | 817-923-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 10416 HOLLYHEAD WAY
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City | YUKON
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State | OK
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Zip | 73099-7517
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Country | US
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Telephone | 405-371-8891
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95153
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP133659
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License Number State | TX
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