MEDICARE: FIDELITY HEALTH AND PSYCHIATRY SERVICES PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1699502088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDELITY HEALTH AND PSYCHIATRY SERVICES PLLC

Provider Business Mailing Address
First Line	:	1251 PIN OAK RD STE 131
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7047
Country	:	US
Telephone Number	:	281-378-4892
Fax Number	:

Provider Business Practice Location Address
First Line	:	27922 COLONIAL POINT DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-3712
Country	:	US
Telephone Number	:	281-378-4892
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FIDELIA ASANTE-ANSONG
Credential	:
Telephone Number	:	281-378-4892

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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