Provider Demographics
NPI:1962964791
Name:ADDAE, ANTHONY AMOAKO
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:AMOAKO
Last Name:ADDAE
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 1:7301 MATLOCK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3405
Mailing Address - Country:US
Mailing Address - Phone:817-813-8055
Mailing Address - Fax:
Practice Address - Street 1:2140 HIGHWAY 157 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4847
Practice Address - Country:US
Practice Address - Phone:682-400-4006
Practice Address - Fax:682-400-4007
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP141172OtherNP LICENCE NUMBER (TEXAS BOARD OF NURSING)