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NPI Code Detail

MEDICARE: FATMA AISHA AHMOUDA PMHNP-BC

MEDICARE: FATMA AISHA AHMOUDA PMHNP-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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2022F061897MO

General Provider Information

NPI Number : 1982311718
Entity Type Code : Individual
Provider Name (Legal Business Name) : FATMA AISHA AHMOUDA PMHNP-BC
Provider Business Mailing Address
First Line : 1301 FIELDCREST
Second Line :
City : COLUMBIA
State : MO
Zip : 65203-1566
Country : US
Telephone Number : 573-529-9734
Fax Number :
Provider Business Practice Location Address
First Line : 1301 VANDIVER DR STE Y
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-3918
Country : US
Telephone Number : 573-449-8338
Fax Number : 573-449-8344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2022
Last Update Date : 11/01/2022

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