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NPI Code Detail

MEDICARE: FRIDAH OBONYO MONGARE PHNP

MEDICARE: FRIDAH OBONYO MONGARE PHNP
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 Practitioner1025041TX

General Provider Information

NPI Number : 1336638253
Entity Type Code : Individual
Provider Name (Legal Business Name) : FRIDAH OBONYO MONGARE PHNP
Provider Business Mailing Address
First Line : 1500 S MAIN ST FL 10
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8111 LBJ FWY STE 900
Second Line :
City : DALLAS
State : TX
Zip : 75251-1322
Country : US
Telephone Number : 469-262-6459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2018
Last Update Date : 02/25/2026

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