MEDICARE: ANTHONIA O EGBEDEJU FNP

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
1	163W00000X	Registered Nurse	149732	TN
2	363LF0000X	Family Nurse Practitioner	APN154784	TN
3	363LF0000X	Family Nurse Practitioner	2019006675	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53-78721-121	OTHER	KS	STATE LICENSE
2	2019006675	OTHER	MO	STATE LICENSE
3	APN15784	OTHER	TN	STATE LICENSE

General Provider Information

NPI Number	:	1568758829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONIA O EGBEDEJU FNP

Provider Business Mailing Address
First Line	:	PO BOX 746079
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6079
Country	:	US
Telephone Number	:	773-352-1513
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	11600 FM 1960 RD W STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3516
Country	:	US
Telephone Number	:	281-720-8639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	05/05/2025

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