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General NPI Number Information
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NPI Number | 1952138794
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Entity Type | Individual
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Provider Name | FANTAMAFAYE NEVELS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 539 W COMMERCE ST # 1822
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City | DALLAS
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State | TX
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Zip | 75208-1953
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Country | US
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Telephone | 225-937-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 6721 SUMMERS DR E APT 365
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City | FORT WORTH
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State | TX
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Zip | 76137-6574
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Country | US
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Telephone | 225-439-9711
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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 | 1031421
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License Number State | TX
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