NPI 1760927172 · live from the CMS NPI Registry
Deepa Tony Abraham
Nurse Practitioner, Family in Fort Worth, TX. National Provider Identifier 1760927172, active.
NPI record
| NPI | 1760927172 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 609 Hemphill St, Fort Worth, TX 76104 |
| Practice phone | 817-923-8484 |
| Mailing address | 10416 Hollyhead Way, Yukon, OK 73099 |
| Enumerated | December 21, 2016 |
| Last updated | March 17, 2018 |
| Sole proprietor | Yes |
| Other names | Deepa Kochethu |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 95153 (OK) |
| Nurse Practitioner, Family primary | 363LF0000X | AP133659 (TX) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.