Provider Demographics
NPI:1730879545
Name:AMBE, AMBESON CORNELL
Entity type:Individual
Prefix:
First Name:AMBESON
Middle Name:CORNELL
Last Name:AMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 ALLIANCE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5577
Mailing Address - Country:US
Mailing Address - Phone:844-824-8775
Mailing Address - Fax:281-648-2200
Practice Address - Street 1:4825 ALLIANCE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5577
Practice Address - Country:US
Practice Address - Phone:844-824-8775
Practice Address - Fax:281-648-2200
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215093363LP0808X
TX1118807363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health