MEDICARE: DEBORAH YVONNE ANTAI-OTONG APRN, 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	226422	TX
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	226422	TX

General Provider Information

NPI Number	:	1952417180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH YVONNE ANTAI-OTONG APRN, BC

Provider Business Mailing Address
First Line	:	2301 E LAMAR BLVD
Second Line	:	SUITE 650
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7415
Country	:	US
Telephone Number	:	817-385-3794
Fax Number	:	817-385-3700

Provider Business Practice Location Address
First Line	:	6000 WESTERN PL
Second Line	:	SUITE 300
City	:	FT WORTH
State	:	TX
Zip	:	76107-4607
Country	:	US
Telephone Number	:	817-530-2230
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/11/2025

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