Provider Demographics
NPI:1982247722
Name:MUDOH, COMFORT (CNM, FNP-C)
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:
Last Name:MUDOH
Suffix:
Gender:F
Credentials:CNM, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 CRUMBCAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4627
Mailing Address - Country:US
Mailing Address - Phone:443-527-4985
Mailing Address - Fax:
Practice Address - Street 1:3201 MATLOCK RD STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2946
Practice Address - Country:US
Practice Address - Phone:817-468-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1095220363LF0000X, 367A00000X
DELK-0000202367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily