Provider Demographics
NPI:1699497388
Name:MENSAH DES BORDES, CHARITY (NP)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:MENSAH DES BORDES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:MENSAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2611 YELLOW PEAR WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1440
Mailing Address - Country:US
Mailing Address - Phone:832-771-3470
Mailing Address - Fax:
Practice Address - Street 1:2611 YELLOW PEAR WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-1440
Practice Address - Country:US
Practice Address - Phone:832-771-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089971363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health