Provider Demographics
NPI:1588067078
Name:OBI, ADA TERESA (FNP-C)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:TERESA
Last Name:OBI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 VALLEY CREST DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7796
Mailing Address - Country:US
Mailing Address - Phone:731-217-6179
Mailing Address - Fax:
Practice Address - Street 1:4593 ELVIS PRESLEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-1511
Practice Address - Country:US
Practice Address - Phone:901-261-7338
Practice Address - Fax:901-345-0909
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily