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NPI Code Detail

MEDICARE: ELSA OBONYO RN, BSN, PMHNP-BC

MEDICARE: ELSA OBONYO RN, BSN, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1114787TX

General Provider Information

NPI Number : 1235827908
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELSA OBONYO RN, BSN, PMHNP-BC
Provider Business Mailing Address
First Line : 6606 SWAINSON TRL
Second Line :
City : ARLINGTON
State : TX
Zip : 76002-3688
Country : US
Telephone Number : 817-500-8007
Fax Number :
Provider Business Practice Location Address
First Line : 4144 N CENTRAL EXPY STE 850
Second Line :
City : DALLAS
State : TX
Zip : 75204-3226
Country : US
Telephone Number : 972-472-2409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2023
Last Update Date : 01/31/2026

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