Provider Demographics
NPI:1932938040
Name:BEDU-ADDO, VIVIAN (NP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:BEDU-ADDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:KEELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2928 ENGLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5522
Mailing Address - Country:US
Mailing Address - Phone:817-797-2726
Mailing Address - Fax:
Practice Address - Street 1:2928 ENGLAND PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-5522
Practice Address - Country:US
Practice Address - Phone:817-797-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157782364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent