MEDICARE: ACTFAST HEALTHCARE LLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1689302861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTFAST HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2000 E ARAPAHO RD APT 22303
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-7709
Country	:	US
Telephone Number	:	972-891-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 E ARAPAHO RD APT 22303
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-7709
Country	:	US
Telephone Number	:	945-249-0615
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	BLESSING OKON OKPO
Credential	:	NP
Telephone Number	:	972-891-1700

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/07/2023

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Directions to “ACTFAST HEALTHCARE LLC ” Practice Location

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