Provider Demographics
NPI:1427808393
Name:MOFOR, KELLY AMAAH (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:AMAAH
Last Name:MOFOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SPRINGTOWN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4074
Mailing Address - Country:US
Mailing Address - Phone:469-286-4531
Mailing Address - Fax:
Practice Address - Street 1:1002 SPRINGTOWN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4074
Practice Address - Country:US
Practice Address - Phone:469-286-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty