Provider Demographics
NPI:1235827908
Name:OBONYO, ELSA (RN, BSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:OBONYO
Suffix:
Gender:F
Credentials:RN, BSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 SWAINSON TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3688
Mailing Address - Country:US
Mailing Address - Phone:817-500-8007
Mailing Address - Fax:
Practice Address - Street 1:6606 SWAINSON TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3688
Practice Address - Country:US
Practice Address - Phone:817-500-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health