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General NPI Number Information
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NPI Number | 1780335992
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Entity Type | Individual
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Provider Name | GRACE AKANGBE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 7777 FOREST LN STE 833
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-566-4591
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Fax |
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Provider Business Mailing Address
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Address Line | 4926 FOXHALL DR
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City | MEMPHIS
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State | TN
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Zip | 38118-6413
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Country | US
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Telephone | 901-596-8246
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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 | 1065480
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License Number State | TX
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